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The aim of this study was to investigate the effect of age at first service ( 50), breeding season (all the year vs. specific season), housing system (shelter vs. grazing and shelter), manager education level ( 200), flock size ( 200) and their interactions on kidding, twining, abortion and stillbirth rates of Ardi goats in Saudi Arabia. Data were collected from 34 goat flocks containing 3700 heads. GLM procedures were used for analysis. The dependent variables in the model were lambing, twining, abortion, and stillbirth rates, while the main effects in the model were age at first service, male/females ratio, breeding season, housing system, manager education level, flock size, and worker/animals ratio. Barren does (n = 104) were examined for the causes of infertility. The results revealed that the means of kidding, twining, abortion and stillbirth rates were 91.5 ± 1.2%, 50.09 ± 5.24%, 3.5 ± 1.4% and 9.47 ± 2.2%, respectively. Does mated by or after 8 months had more twins than those mated before this age (P = 0.006). Flocks with male/females ratio of 1:>50 showed higher stillbirth rate (P = 0.01). Shelter-raised goats had a higher twining rate (P = 0.01) and a lower abortion rate (P = 0.001). Flocks raised in a shelter system with a worker/animal ratio of 1:100 had a higher kidding rate (P = 0.02) and lower abortion rate (P = 0.0001) than those with the same ratio but raised in a mixed grazing and shelter system. Flocks with managers with a ≥ secondary school education had a higher twining rate (P = 0.002). The most common findings in barren goats were pyometra, ovarian inactivity, abnormal vaginal discharges, and hydrometra. In conclusion, management has a profound effect on the reproductive performance of Ardi goats in Saudi Arabia and should be always considered when attempting to improve their production.

Background Nephrotic syndrome (NS) is the most frequent glomerular disease among children. Renal biopsy is the most precise procedure for diagnosing and following childhood NS; however, it is an invasive procedure with potential complications. As a result, early non-invasive diagnostic and prognostic indicators and new treatment targets are urgently needed for this disease. Purpose To assess the miR-142-5p expression in peripheral blood as an indicator of the autoimmune processes in children with NS and the role of differential microRNAs (miR) expression and expression panels in diagnosing and predicting the response to steroid treatment in children with NS. Methods Eighty (80) children with NS and 100 subjects matched for age and gender used as controls constitute the study sample in this case-control study. MiR-142-5p, miR-191, miR-181-5p, miR-30a-5p and miR-50a-5p expression are measured in all enrolled children by real-time PCR. We assessed the sensitivity and accuracy of different MicroRNAs panels. Results miR-142-5p, miR-191, miR-181-5p, miR-30a-5p and miR-150a-5p expressions were significantly increased in the children with NS than controls. There was a significant difference in the five mRNAs differential expressions between steroid-resistant and steroid-sensitive children with NS. Of the selected five microRNAs, miR-142a-5p was the best to allow very good discrimination of the children with NS and predict steroid resistance (AUC = 0.965 and 1.00, respectively), suggesting the possible autoimmunity processes' role in the pathogenesis of NS and the resistance to steroids. The (miR-142a-5p with miR-181a-5p and miR-30a-5p) was the best expression panel to diagnose new NS cases and predict steroid resistance. Conclusions microRNAs expressions, either differential or as a panel, are important for early diagnosing childhood NS and may provide a non-invasive clue for the response to steroid treatment in these patients. The (miR-142a-5p, miR-181-5p, and miR-30a-5p) panel was the best one to cover both the diagnosis of the new cases and prediction of response to steroid treatment. Autoimmunity has an important role in NS pathogenesis and resistance to steroid treatment.

Objectives To compare the outcome for DBT-detected and DM-detected suspicious AD, to evaluate the risk of malignancy and if is affected by the US or MRI imaging correlation. Methods All cases with suspicious AD (ultimately assigned BI-RADS 4 or 5 categories) were retrospectively included. Two radiologists independently reviewed DM and DBT images in two sessions for detection (DM vs. DBT). US and MRI imaging correlation findings were recorded. Pathologic results were compared between DBT-detected and DM-detected AD. Results Among 137 detected ADs, 103 (75.2%) were DM-detected, and 34 (24.8%) were only DBT-detected (p = 0.01). The malignancy rate was lower for DBT-detected than DM-detected AD (14.7% vs. 45.6%) (p = 0.01). Malignancy rate was higher with US-positive than US-negative correlation at DM-detected AD (49.4% vs. 27.8%) (p = 0.01). Malignancy rate was not different for DBT-detected AD with (16.7%) or without (12.5%) sonographic correlation. NPV based on radiologists' level of suspicion was high (86.2%-97.2%) but not sufficient enough to forgo biopsy. Of 34 sonographically occult ADs, a positive-MRI correlation was identified in 19 (55.9%) ADs (7 were malignant, 12 were benign). A negative-MRI correlation was identified in 15 (44.1%) ADs; all had a benign outcome (p = 0.01). Conclusions DBT-detected AD is less likely to represent malignancy than does DM-detected; however, the risk of malignancy is not low enough to forgo biopsy. MRI-negative correlation in sonographically occult AD was significantly associated with benign outcomes and can avoid unnecessary interventions.

Background: Hemophilia is an X-linked heritable coagulopathy with an overall prevalence of approximately 1 in 10,000 individuals. Hemophilias are rare X linked hereditary bleeding disorders. Platelets may be among the determinants of variability in bleeding phenotype. Objective: To evaluate the platelet function tests in patients with hemophilia, and to explore the influence of platelet dysfunction on hemophilia bleeding score. Patients and Methods: The study was conducted on 40 hemophilic patients and 20 normal persons as a control in outpatient clinics at Kafr El-Sheikh Governorate Hospitals and Al-Azhar University Hospitals (Al-Hussein and Sayed Galal) to evaluate the platelet function tests in patients with hemophilia, and to explore the influence of platelet dysfunction on hemophilia bleeding score. Results: The majority of cases (35 patients 87.5%) were type A and (5 patients 12.5%) were type B. As regard to hemophilia scoring system (HSS), 3 patients (7.5%) were type 1, 19 patients (47.5%) were type 2 and 18 patients (45%) were type 3. Bleeding from the knee occurred in the majority of patients (77.5%), from the elbow occurred in 32.5%, from the ankle occurred in 5%, from the vagina occurred in 15% and from the nose and the gum occurred in 7.5%. Platelets and maual platelet count showed insignificant difference between both groups. Platelets aggregation tests (ADP) test, collagen and restocetin agonists test) were significantly lower in cases group than control group. Prothrombin time (PT), international normalized ratio (INR), bleeding time (BT) showed insignificant differences between both group. On the other hands, activated partial thromboplastin time (APTT) significantly prolonged cases group than control group. No hemophilia C cases were detected in our study. Conclusion: There was a statistical significant relationship between bleeding phenotype in hemophilia B and platelet function. Diagnosis of hemophilia was confirmed by factor VIII assay for hemophilia A and factor IX assay for hemophilia B.

Background: The liver is the primary site of synthesis of nearly all coagulation factors, along with several proteins involved in fibrinolysis and anticoagulation, The acute and chronic inflammation in the liver is associated with a bleeding diathesis due to deficiency in the synthesis of coagulation factors as well as a pro-coagulant state due to the defects in the synthesis of anticoagulant factors by the liver. Objective: To assess the tissue factor in cirrhotic and hepatocellular carcinoma (HCC) patients and their coagulation profile. Patients and methods: This was a case control study carried on Al-Mahala General Hospital, and conducted on 80 subjects. They were categorized into in to main two groups: Group A (60 patients) and Group B (20 control persons) from March 2019 till September 2019. Results: There was a statistical significant difference between tissue factor expression and other laboratory parameters among the studied group. There was a significant positive correlation between tissue factor and alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine, total bilirubin, α-fetoprotein (AFP), international normalized ratio (INR) and activated partial thromboplastin time (APTT). Also there was a significant negative correlation between tissue factor and hemoglobin, albumin and platelets. Conclusion: Tissue factor (TF) enhances the inflammatory process within the liver parenchyma as it induces release of pro-inflammatory cytokines. This raises the possibility of a potential role for anti-inflammatory substances as a potential therapeutic option that can ameliorate liver damage in those patients.

Background: Thyroid disorders are considered the second most common endocrine disorders affecting women during their reproductive years and can impact up to 4% of all pregnancies. Of all thyroid disorders, hypothyroidism is the most prevalent, impacting approximately 2- 3% of all pregnancies. Hyperthyroidism is far less prevalent, impacting approximately 0.2% of all pregnancies.Aim of the Work: To assess the level of urinary iodine in 1st trimester of pregnancy and its relation with thyroid hormones level and autoimmunity status.Subjects and Methods: To elucidate this aim 100 healthy pregnant female in their 1st trimester of pregnancy were included in the study. They were collected from Obstetrics and Gynecology Department El Demerdash hospital and Dar El shefa Hospital in the period from September, 2020 to November, 2020.Results: Median urinary iodine was 55(41.0-76.0) μg/l and their was99 females had insufficient iodine intake less than 150μg /l, one had adequate intake (150-249) μg /l and none showed more than necessary intake (250-499) μg /l or excessive intake more than 500 μg /l. As regard thyroid ultrasound there was normal Thyroid volume in 94 subjects,(94.0%)., increased volume in 6 subjects (6%). There was a Significant negative correlation between each of the following the age and the gestational age; and urinary iodineConclusion: There was a significant iodine deficiency in pregnant women within the study area, indicating that some women may need to increase their iodine intake during pregnancy. Additionally, diagnosis and treatment of thyroid dysfunction during pregnancy should be based on pregnancy and method specific reference intervals, and more detailed staging is needed to assess pregnant women's thyroid function.

Introduction: Third trimester bleeding is one of the majorobstetric emergencies, which contribute greatly to maternaland fetal morbidity and mortality. It is defined as bleeding from or into the genital tract prior to delivery of thebaby anytime from 20 weeks gestation, in some developedcountries or 24 weeks gestation, in others or 28 weeks incountries with low resource settings thus lacking adequateneonatal support incubators.The aim of this study: The study aimed to elucidate theoutcomes with the associated morbidities, which will help define the magnitude of the problem posed by antepartumhemorrhage in order to better the management measuresavailable to promptly tackle and alleviate this condition.Patients & Methods: This study was prospective observational study conducted in Department of Obstetrics andGynecology, Faculty of Medicine, Fayoum UniversityHospital and El-Sahel Teaching Hospital. All cases of antepartum hemorrhage admitted to emergency unit at maternity hospital after the age of 28 week of gestation during theperiod from (1st of August 2019 to end of November 2020)were included in this study, meeting the inclusion and exclusion criterion.Results: Total number of patients who were admitted toobstetric department with APH during the study period was120 case of them 25 cases were elective and all of themwere placenta previa cases and 95 cases were emergency.67 cases (55.83%) with placenta previa (25 elective and 42emergency) & 44 (36.636%) with accidental hemorrhage(all are emergency or urgent cases), 9 (7.5%) due to othercauses. Maternal outcome in PP include Increased numbersof CS 67 case (100%), Increased number of units of bloodtransfusion (1-18) unit with mean 4.31 ± 3.27, Hysterectomy 21 case (31.3 %), Shock 29 case (43.3 %), Urinary injury either bladder or ureteric injury 5 cases (7.5 %) (4cases bladder injury and 1 case Ureteric injury) all of themwere placenta percreta, ICU admission 14 case (20.9 %),postpartum hemorrhage occurred in 6 cases and maternalmortality one case (1.5%). While maternal out come in accidental hemorrhage patients was numbers of CS delivery was 35 cases and 9 cases delivered vaginally,number of units of blood transfusion (1-18)unit with mean 3.57 ± 3.08, Hysterectomy 3cases (6.8%), Shock 22 case (50%),Conclusion Previous CS was found to be the mostimportant risk factor for Placenta praeviaand accreta Pre-eclampsia& previous abruption were the most important risk factors forabruption. Fetal morbidities associated withboth placenta previa & abruption were prematurity, low birth weight, low Apgar score,admission to NICU.

Yasmine Samir Galal,1 Walaa Ahmed Khairy,1 Ahmed Ali Taha,2 Tarek Tawfik Amin1 1Public Health and Community Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt; 2Vascular Surgery Consultant, National Institute of Diabetes and Endocrinology, Cairo, EgyptCorrespondence: Walaa Ahmed KhairyPublic Health and Community Medicine Department, Faculty of Medicine, Cairo University, Kasr Alainy Street, Cairo, 11562, EgyptTel +20-1223682081Email Walaa.khairy@kasralainy.edu.egBackground and Purpose: Diabetic foot ulcers (DFUs) markedly contribute to morbidity and mortality of diabetic patients. Hence, this study was conducted to investigate the predictors of foot ulcers among Egyptian diabetic patients.Methods: A case-control study was conducted among 488 diabetic patients attending the inpatient departments and outpatient clinics at the National Diabetes Institute in Egypt. A pretested data collection sheet was designed to collect and record the following: socio-demographic data, diabetic history and lifestyle characteristics, recorded comorbidities, and the results of foot examination.Results: Significant positive predictors of DFUs on multivariate logistic regression analysis included presence of three or more comorbidities; two or more diabetic complications; callus; and flatfoot. Significant protective (negative) predictors were management of diabetes by diet, oral hypoglycemic drugs (OHGs), and insulin; and intact vibration sense.Conclusion: Significant positive predictors of DFUs on multivariate analysis were presence of three or more comorbidities, two or more diabetic complications, callus and flatfoot, while protective predictors were management of diabetes by diet, OHGs, and insulin; and intact vibration sense. Hence, close monitoring should be provided to diabetic patients with comorbidities and complications to reduce the risk of DFUs.Keywords: diabetic foot ulcers, comorbidities, peripheral vascular disease, foot deformities

Background: Asthma is the most common chronic inflammatory disease of the pulmonary system. The prevalence of asthma is growing enormously worldwide posing a significant health and economic burden. Asthma treatment guidelines recommend a combination of inhaled corticosteroid (ICS) and long-acting beta 2 agonist (LABA). However, there is little guidance for clinicians on selecting a specific ICS/LABA combination. Aim: To compare the effectiveness of three fixed dose ICS/LABA combination therapies i.e., fluticasone/salmeterol, fluticasone/formoterol and budesonide/formoterol for the management of moderate to severe asthma. Design: This was a prospective interventional, three-armed, parallel group, open label, and randomized clinical trial Methods: Adult asthmatic patients of both genders (n=135) were randomly allocated to the three ICS/LABA treatment groups: fluticasone/salmeterol-treated group (n=45) , fluticasone/formoterol-treated group (n=45) and budesonide/formoterol-treated group (n=45). All groups were treated for three months. The main outcome parameters included lung function (FEV1, FEV1%, FEV1/FVC), inflammatory state (hs-CRP, ECP) and asthma control (ACT). Results: After 3 months of treatment, fluticasone/formoterol significantly increased FEV1 compared to fluticasone/salmeterol (p

BACKGROUND: Healthcare workers (HCWs) are at the frontline defense against coronavirus disease 2019 (COVID-19) pandemic. AIM: The study aimed to describe the characteristics and appraise potential risk factors of COVID-19 transmission among HCWs who tested positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in one of Cairo University Hospitals. METHOD: Cross-sectional descriptive analysis of confirmed polymerase chain reaction (PCR) positive versus negative cases for COVID-19. RESULTS: Through March–June 2020, (145/846; 17%) suspected HCWs were tested for COVID-19 by PCR; out of them (70/145; 48.3%) were confirmed as positive, these positive cases represented (70/846; 8.3%) of all HCWs of the hospital. About 33% of confirmed COVID-19 positive HCWs acquired the infection from the healthcare while only (13/70; 19%) from community settings, and no clear exposure data were identified in (34/70; 48%) of cases. Most of symptomatic cases showed a positive PCR test for SARS-CoV-2 versus asymptomatic cases, p < 0.001. There was no statistical significance regarding gender, age, presence of comorbidity, workload or the type of acquisition. CONCLUSION: HCWs are at an increased risk of COVID-19 infection at the workplace. Strict implementation of infection control measures is of crucial role in preventing transmission of COVID-19 infection in health-care settings.

Objective Rheumatoid arthritis (RA) is regarded as the commonest and one of most known inflammatory arthritis. Our study was to determine the effects of laser therapy and laser acupuncture therapy on RA elderly patients. Subjects and Methods Forty patients with age of 65 to 75 years were being randomly allocated to 2 groups. Group(A) included twenty participants having RA treated via low level laser therapy. Group(B) included twenty participants having RA treated via laser acupuncture. All the patients underwent treatment by methotrexate. Treatments were provided three times each week to the two groups for twelve weeks.Independent laboratory technician and statistician were blinded to the study groups. Results There was significant reduction in scores of RAQoL questionnaire pre as well as post treatments for both the groups, with p

Toxoplasma gondii infection causes high rate of gestational and congenital infection across the globe and is considered a both a public health problem and a neglected disease. The study was carried out to determine the prevalence of anti-Toxoplasma gondii antibodies and the associated risk factors among pregnant women attending antenatal care in some Primary Health Centres in Jos, Plateau State, Nigeria. In this cross-sectional study carried out within 5 months between Jan – May 2019, a total of 182 blood samples were collected from consenting pregnant women. Structured questionnaire was used to obtain data on socio-demography and risk factors. Three millilitres (3 ml) of blood samples were collected from the study participants. Sera were separated from the blood and evaluated for anti-Toxoplasma gondii antibodies (IgG and IgM) using enzyme-linked immunosorbent assay (ELISA). The data collected from the experiment were analysed using Statistical Package for the Social Sciences. Out of the 182 samples examined, 84 (46.2%) had anti-Toxoplasma gondii IgG antibody, 2 (1.1%) had IgM antibody while 98 (53.4%) were neither seropositive for IgG nor IgM. Trimester of pregnancy was significantly associated with prevalence of anti-Toxoplasma IgM antibody. In conclusion, Toxoplasmosis is prevalent in Jos. Eleven out of every 1000 women (i.e. 1.1%) had recent toxoplasmosis and 53.4% were not protected against primary infection thereby underscoring the need for prevention and control during pregnancy through enlightenment.

The bursal cytokine gene expression and apoptosis were compared in vaccinated chickens with either live or immune-complex infectious bursal disease virus (IBDV) vaccines with or without virulent IBDV challenge. The cytokine gene expressions were evaluated at 5 and 12 day-post-challenge (DPC). The apoptotic marker Caspase-3 was determined by IHC on collected bursae, thymus, spleen, and kidneys at 12 DPC. A significantly decreased bursal cytokine levels were observed in the all-vaccinated birds except for IL-6 in the classic IBD vaccines at 5DPC. A significant upregulation of the IL-2 was observed in the live IBD vaccinated birds. No significant differences in the bursa and thymus Caspase-3 positive cells. However, splenic and renal apoptosis was significantly higher in the live IBD vaccine groups. Results indicate that both vaccine types reduce the IBDV-induced bursal proinflammatory cytokines and apoptosis. However, classic IBD vaccines failed to clear the challenge virus or reduce splenic and renal apoptosis.

Faidherbia albida is one of the plants that have been traditionally used throughout the world in the treatment of diabetes. In previous studies, various parts of the plant such as the methanolic root bark, aqueous seed, and the aqueous stem bark extracts have been tested on alloxan-induced diabetic rats for their anti-hyperglycemic activity. In the current study, the anti-hyperglycemic activity of the total ethanolic extract of Faidherbia albida fruits was evaluated in nicotinamide-streptozotocin-induced diabetic mice using glimepiride as a reference anti-diabetic drug. The total ethanolic fruit extract at 200 mg/kg body weight significantly (p < 0.05) lowered the blood glucose level in diabetic mice by (74%) after 4 hrs of oral administration while the peak hypoglycemic effect of glimepiride (55.2%) occurred at the 4th hr after oral administration. The results provided evidence that Faidherbia albida fruit extract is recommended to be used as a hypoglycemic drug in treating diabetic patients.

Background: The wrist and hand joints are complex structures with an extensive differential diagnosis for a pre-senting mass. However, the vast majority of wrist and hand masses are benign. Magnetic Resonance Imaging (MRI) by virtue of its ability to provide detailed soft tissue characteri-zation is the preferred method of imaging the problematic soft tissue masses. Aim of Study: To evaluate the role of MRI in diagnosis of the most commonly encountered soft tissue masses of the wrist and hand, describing their main features; specifically the signal characteristics and location that helps to differentiate them. Methods: This cross section study included 42 patients (22 females and 20 males), their ages range between 1 year and 79 years, with mean age of 32.24 year. The study was performed in Radiology Department El-Demerdash Hospital between March 2018 and September 2019. Results: Benign and malignant lesions represented (97.6%) and (2.4%) respectively of the encountered lesions. The most commonly found lesions were ganglia (33.3%). The most frequently seen solid tumors, included Giant Cell Tumor of the Tendon Sheath (GCTTS) (9.5%), benign Nerve Sheath Tumors (NST) (4.8%), lipoma (2.4%), hemangioma (4.8%)/ vascular malformation (9.5%), fibroma of the nerve (4.8%) and malignant lesions (2.4%). Joint and soft tissue infection were encountered in (2.4%) of cases. A specific diagnosis was made, or strongly suspected, from the MRI features found in certain conditions like ganglion, hemangioma, arteriovenous malformation, giant cell tumor of the tendon sheath, lipoma, fibroma, and soft tissue infections. MR imaging of the wrist and hand provides a wealth of information regarding the status of and the relationship of the osseous and soft tissue compo-nents, both of which are necessary to confirm the clinical diagnosis and manage the patient in the most efficient way possible. Conclusion: Magnetic resonance imaging is the imaging method of choice for evaluating the presence and extent of soft tissue masses. It is particularly useful for assessing masses in the wrist and hand, where lesions are predominantly benign.By noting the signal characteristics and determining the lesion location, a specific diagnosis of the mass can often be made. unfortunately, when lesion doesn't exhibit typical features, differentiation from malignancy can't be categorically made.

Objective: To assess the risk factors which determine the magnitude of post-tonsillectomy hemorrhage. Study Design: Prospective cross sectional study. Setting: A study carried out at otolyrangical unit at a tertiary care Isra University hospital Hyderabad, from June 2018 to April 2019. Materials and Methods: 110 pediatric patients age 5-17 years were included in this study. We administrated a structured questionnaire to parents of the patients. We selected cases for tonsillectomy as per criteria of the American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS). Those patients with a history of recurrent tonsillitis presented at the otolaryngology department were included. Patients with a history of use of anticoagulant therapy, obstructive sleep apnea, patients with a history of a bleeding disorder, and patients not giving consent were excluded. We diagnosed patients selected for tonsillectomy included with recurrent tonsillitis, peri-tonsillar hypertrophy, and tonsillar hypertrophy. Patients were observed and followed for postoperative hemorrhage. Data were analyzed by using Statistical Package for Social Sciences version 21 (SPSS 21). Results: Among 110 children included in the study, 41.8% patients were in the age group of 5-10 years, 30% were in the age group of 11-15 years and 28.2% were over 15 years. Among 110 patients 21.8% underwent tonsillectomy were diagnosed as recurrent tonsillitis, 19% were diagnosed as having tonsillar hypertrophy, 40.0% were suffering from both recurrent tonsillitis and tonsillar hypertrophy and 19.2% had peritonsillar hypertrophy. This shows that 14.5% were admitted to the hospital after 1-5 days, 58.1% developed post-tonsillectomy hemorrhage after 6-10 days and 27.2% developed post-tonsillectomy hemorrhage after 10 days. Conclusion: We conclude that age >10 years was significant predictive risk factors for post-tonsillectomy hemorrhage among children who undergo tonsillectomy.

Purpose While there is literature that examines factors associated with low participation in cancer screening among Canadian ethnic groups, there is limited understanding of black visible minorities, particularly Somalis. Thus, the purpose of this study is to synthesize knowledge pertaining to the perceptions, beliefs and barriers of Somali women and men toward screening for breast, cervical and colorectal cancers in countries such as Canada. Design/methodology/approach The scoping review methodology was used to search for peer-reviewed articles that explicitly examined perceptions, beliefs and barriers among Somalis toward screening for breast, cervical and colorectal cancers in developed countries. The following electronic databases were searched without time frame restrictions, namely, OVID Medline, Embase, CINHAL, PubMed, Scopes and ProQuest. A total of 402 peer-reviewed articles were identified and screened. Three articles were identified through reference list screening (one eligible) and consultation with experts in the networks (two eligible). In total, 12 studies met the inclusion criteria for synthesis. Thematic analysis was used to analyze the selected articles for key themes and the synthesis was informed by the socio-ecological model. Findings The majority of studies originated from the USA and focused primarily on Somali women and cervical cancer screening. Themes that emerged from the literature include individual-level negative experiences and socio-cultural perceptions/beliefs; community-level barriers in cancer screening; and systemic challenges in navigating the health-care system. Many of the studies focused on individual and community-level determinants of cancer screening, with little attention to systemic level determinants. Other gaps identified include factors influencing Somali men’s low participation in cancer screening; limited studies on colorectal cancer and Somali women; and specific cancer-screening barriers faced by Somalis within the Canadian context. Originality/value The findings of the review reveal multiple cancer screening challenges for Somali communities and the gained insights should inform both health and social care practitioners and policymakers.

Coronavirus disease 2019 (COVID-19) is a devastating worldwide pandemic infection caused by a severe acute respiratory syndrome namely coronavirus 2 (SARS-CoV-2) that is associated with a high spreading and mortality rate. On the date this review was written, SARS-CoV-2 infected about 96 million people and killed about 2 million people. Several arguments disclosed the high mortality of COVID-19 due to acute respiratory distress syndrome or change in the amount of angiotensin-converting enzyme 2 (ACE2) receptor expression or cytokine storm strength production. In a similar pattern, hepatic impairment patients co-infected with SARS-CoV-2 exhibited overexpression of ACE2 receptors and cytokine storm overwhelming, which worsens the hepatic impairment and increases the mortality rate. In this review, the impact of SARS-CoV-2 on hepatic impairment conditions we overviewed. Besides, we focused on the recent studies that indicated cytokine storm as well as ACE2 as the main factors for high COVID-19 spreading and mortality while hinting at the potential therapeutic strategies.

Objectives Permanent pacemakers are widely used in the pediatric population due to congenital and surgically acquired rhythm disturbances. The diversity and complexity of congenital heart diseases make device management a highly individualized procedure in pediatric pacing. We are also faced with special problems in pediatric age group as growth, children's activity and infection susceptibility. This study aimed to present our institute's experience in pediatric and adolescent pacemaker implantation and long-term outcomes. Methods This cross-sectional observational study included 100 pediatric patients who visited our outpatient clinics at Ain Shams University Hospitals for regular follow up of their previously implanted permanent pacemakers. All patients were subjected to history taking, clinical examination, ECG recording, echocardiography and elaborate device programming. Data about device types, device components' longevity, subsequent procedures, complications were collected, with comparison between epicardial and endocardial pacemakers. Results Our study population ranged in age from 8 months to 18 years (mean 13.12 ± 5.04 years), 51 were males and 53 patients had congenital heart disease. Epicardial pacing represented 26% of our total population using only VVIR pacemakers, while endocardial pacing represented 74% of our population with 58.1% of them being VVIR pacemakers. First battery longevity was higher in endocardial batteries (108 months vs. 60 months, p value: 0.007). First lead longevity was also higher in endocardial leads (105 moths vs. 58 months, p value: 0.006). Complication rate was 25%; 8 patients had early complications (one insulation break in endocardial group). Late complications occurred in 17 patients (10 patients had lead fracture; 9 of them were endocardial, 2 insulation breaks in endocardial leads, 3 patients from epicardial group had lead failure of capture). In total, 16 patients had lead-related complications. There was no statistically significant difference between different lead models regarding lead-related complications. Conclusion Pacemakers in children are generally safe, but still having high rates of lead-related complications. Lead failure of capture was more common in epicardial leads. These complications had no relation to the model of the leads. Endocardial pacemakers showed higher first lead and first battery longevity compared to epicardial pacemakers.

Background: Serum magnesium is associated with anemia. But the roles of magnesium in anemia and erythropoietin (EPO) responsiveness remain not well knwon in maintenance hemodialysis (MHD) patients. Objective: to study the level of serum magnesium and its relationship with EPO responsiveness in MHD patients. Patients and methods: This study was done in hemodialysis unit at Bab El-Shaareya University Hospital, during the period of January 2020 to June 2020. A total of 60 regular hemodialysis (RHD) patients were recruited for this survey. Their anthropometrics and laboratory data were collected. EPO responsiveness was evaluated by the erythropoietin resistance index (ERI). The patients were divided into 2 groups according to EPO resistance Index (ERI) Group A, the patients with higher ERI than 1.52, and group B with lower ERI than 1.52. Multivariate logistic regressions were conducted to evaluate the factors that may be associated with EPO responsiveness. Results: The mean serum magnesium level was higher than normal levels in RHD patients, while nearly no hypomagnesemia was observed. A multivariate logistic regression model revealed that lower serum magnesium levels were correlated with a high ERI. The OR of a high ERI was found to be 2.89 (93% CI 1.197–4.715, p = 0.005) for group A and 1.57 (94% CI 0.779––2.941, p > 0.05) for group. Conclusion: Serum magnesium levels were found to be higher than normal levels in RHD patients. A high serum magnesium level was shown to be correlated with good EPO responsiveness and it has a protective role from EPO hyporesponsiveness.

Background: Post-date pregnancy carries many fold problems for both pregnancy and fetal outcome. Abnormal middle cerebral artery Dopplers are strongly associated with preterm delivery and antenatal steroid administration. Objective: To identify the relationship between middle cerebral artery Doppler, Amniotic fluid index and perinatal outcomes in postdated pregnancies. Patients and Methods: This study was performed on 50 pregnant women whose gestational age was 40–42 weeks’ gestation attending the antenatal clinic of Zefta General Hospital. The study was done during the period between December 2017 and August 2019.Inclusion criteria included singleton living fetuses with vertex presentation in postdated pregnancies (40 – 42) week gestation. Exclusion criteria included cases with premature rupture of membranes, antepartum hemorrhage and maternal medical disorders as hypertension, diabetes mellitus, hepatic, cardiac, renal or anemia with pregnancy, patients with uterine scar. All patients were subjected to detailed history taking, physical examination and routine investigations including complete blood picture, Rh typing, fasting blood sugar, liver functions, kidney functions and urine analysis. Ultrasound and Doppler study were done twice weekly till the onset of labor or termination of pregnancy in order to assess GA, estimated fetal weight (EFW), placental site and grading, amniotic fluid volume (AFV) (oligohydramnios was diagnosed if the largest vertical pocket less than 2 cm), Doppler study of the MCA. The study population was divided into two groups based on the presence or absence of adverse perinatal outcome. Results: Expected fetal weight (EFW), resistive Index of middle cerebral artery (MCA) and resistive Index of umbilical artery (UA) were not significantly predicting perinatal outcome of postdated pregnancies among the studied pregnant women. Amniotic fluid index (AFI) and biophysical profile (BPP) were significant predictors for perinatal outcome of postdated pregnancies. Conclusion: Resistive Index of (MCA) was not significant predictor for perinatal outcome of postdated pregnancies. Amniotic fluid index was significant predictor for perinatal outcome of postdated pregnancies.

Background: Postoperative arrhythmias are an important cause of morbidity and mortality after cardiac surgery for congenital heart disease. In the early postoperative period, patients with congenital heart disease are especially vulnerable to rhythm disturbances. Objective: This study aimed to assess safety and efficacy of prophylactic amiodarone and magnesium sulphate in preventing cardiac arrhythmia especially junctional ectopic tachycardia (JET) in children with congenital heart disease (CHD) who undergo open heart surgery. Patients and Methods: This was a comparative clinical trial that was conducted on 48 cases at Cardiothoracic Department and Pediatric Cardiology Unit, Zagazig University Hospitals. The cases were divided into three groups according to received drug; Group (A): patients receiving placebo, Group (B): patients receiving magnesium sulfate and Group (C): patients receiving amiodarone. Results: There were highly statistically significant differences between groups as regard to Inotrope Score intraoperatively, heart rate and median arterial pressure postoperatively, postoperative Inotrope Score and drug complications where P

Brain metastases are refractory to therapies that control systemic disease in patients with human epidermal growth factor receptor 2 (HER2+) breast cancer, and the brain microenvironment contributes to this therapy resistance. Nutrient availability can vary across tissues, therefore metabolic adaptations required for brain metastatic breast cancer growth may introduce liabilities that can be exploited for therapy. Here, we assessed how metabolism differs between breast tumors in brain versus extracranial sites and found that fatty acid synthesis is elevated in breast tumors growing in brain. We determine that this phenotype is an adaptation to decreased lipid availability in brain relative to other tissues, resulting in a site-specific dependency on fatty acid synthesis for breast tumors growing at this site. Genetic or pharmacological inhibition of fatty acid synthase (FASN) reduces HER2+ breast tumor growth in the brain, demonstrating that differences in nutrient availability across metastatic sites can result in targetable metabolic dependencies.

Background: In late December 2019 a new (novel) coronavirus was identified in China causing severe respiratory disease including pneumonia. It was originally named Novel Coronavirus and The World Health Organization (WHO) advised the following language associated with the virus. The virus causing the infection has been named - severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 is spreading between people globally and can be seen on the WHO situation reports dashboard which is updated daily (1) Aim of the Study: Establishing an isolation hospital for patients infected with the emerging coronavirus, Covid 19, to relieve pressure on the rest of hospitals and provide the highest health care for patients Methodology: SWOT analysis, TOWS analysis, Brain Storming, Feasibility study, Budgeting of the project, Legal study, and establishment of : risk management plan, financing plan . Conclusion: To open new isolated hospital you should have advantages and more services over your surrounded competitors . Study SWOT analysis is important to supply unique healthcare services. It is mandatory to plan for the Budgeting of the project to include losses and maximize profits

OBJECTIVES To examine the gender-related differences in the presentation, management and outcomes of patients admitted with acute renal colic at our institution. PATIENTS AND METHODS A retrospective analysis of 231 consecutive patients requiring inpatient admission for acute renal colic between October 2015 and March 2018. For each admission, data on demographics, admission blood results, stone characteristics, management and outcomes were collected. Differences between genders were compared using the chi-squared and Student's t-test. RESULTS Gender distribution was 35% female: 65% male. There was no significant difference in age, American Society of Anesthesiologists Physical Status Classification grade or history of diabetes. Women had a higher admission C-reactive protein level (89.3 vs 32.9 mg/L, P < 0.001) and neutrophil count (10.0 vs 8.8 × 109 /L, P = 0.04) than men. They also had more positive cultures (34.1% vs 6.0%, P < 0.001) and were more likely to require percutaneous nephrostomy insertion (9.8% vs 0.7%, P = 0.005). Women had more intensive therapy unit (ITU) admissions (12.2% vs 0.6%, P < 0.001) and longer lengths of stay (4.4 vs 1.8 days, P < 0.001) than men. There was no mortality in our series. CONCLUSION In the present study, women admitted with acute renal colic were more likely to have an associated infection than men and require rapid decompression. Although there was no difference in mortality, women experienced greater morbidity as evidenced by the higher rate of ITU admissions and longer length of stay. These differences are important to consider when assessing the suitability of conservative management for female patients.

Pulmonary arterial hypertension (PAH) is considered to be a rare progressive disease resulting from restricted flow through the pulmonary arterial circulation resulting ultimately in right-sided heart failure. Most patients with PAH suffer from sleep disorders, reduced aerobic fitness, and mortality risk despite optimized medical treatment. This study investigated the effect of 12 weeks of aerobic training on sleep quality, sleep efficiency, right ventricular systolic pressure (RVSP), and aerobic fitness in patients with PAH. Thirty patients with PAH were randomized to two equal groups, training group (A) and control group (B). The Pittsburg sleep quality index (PSQI) questionnaire and a wrist-worn actigraph were used for the assessment of sleep quality and sleep efficiency respectively. RVSP was measured using echocardiography. Cardiopulmonary exercise testing (CPET) assessed maximal heart rate and VO2max. All were measured before and after the study period for both groups. Exercise training was conducted on a bicycle ergometer as an individually-tailored moderate-intensity aerobic training session (60 to 70% of the maximal heart rate reached during the initial exercise test) for 30 to 45 min/day, 3 sessions/week for 12 weeks (36 sessions). Sleep scores and RVSP showed significant reductions and VO2max—representing the aerobic fitness—showed a significant increase in the group (A) compared with group (B). These results suggest that aerobic training has a positive effect on three risk factors for mortality in patients with PAH, namely sleep quality, decline in exercise capacity, and right ventricular remodeling. Clinical trial registered in ClinicalTrials.gov , ID: NCT04337671.

Catheter ablation for atrial fibrillation (AF) has become an established treatment to control symptoms. AF ablation either by cryoballoon or radiofrequency using three-dimensional (3D) electroanatomical mapping exposes patients and medical staff to increased doses of radiation. To compare radiation exposure in patients during cryoballoon ablation compared to 3D electro-anatomic mapping catheter ablation in AF patients. A total of 30 patients referred for AF ablation underwent full history taking, 12-lead ECG, echocardiogram, and pulmonary vein isolation either by 3D mapping system or cryoballoon. Procedure duration and fluoroscopy time were collected and analyzed. Radiation exposure was measured using thermoluminescent dosimeters placed at different sites related to patients and medical staff. The procedural time was statistically significantly longer with 3D mapping compared to cryoballoon but showed no significant difference regarding fluoroscopy time. There was a significantly higher radiation skin dose at the right scapular area in the cryoballoon ablation group, in addition to higher peak skin dose compared to the 3D mapping ablation group. There was no statistically significant correlation between peak skin doses and fluoroscopy duration but a statistically significant correlation between peak skin dose and usage of high frame rate and the high dose area product. Cryoballoon ablation was found to be associated with higher peak skin radiation doses especially in the right scapular area. Knowing dose area product and peak skin dose is more important than fluoroscopy time alone.

Background: Attention Deficit Hyperactivity Disorder (ADHD) refers to the existence of marked difficulties in terms of distractibility, impairment of attention and hyperactivity with a subsequent development of substantial impairment in academic and social functioning. Language impairment (LI)is a predominant co-morbidity in pediatrics with psychiatric illnesses and behavioral troubles. In children with LI, one of the common psychiatric disorders is ADHD. However, LI is a common co-morbidity which often could be detected in ADHD children. Although language problems are not among the main symptoms or needed to fulfill current diagnostic criteria of ADHD, most ADHD children have additional defects in language skills.Objective: The main purpose of the current study was to assess language profile in ADHD children at school age and to specify aspects of language defect in comparison with their normal peers.Patients and Methods: 60 children in the school age (6-10 years) of both genders divided in to two groups, case group: 30 children with ADHD and control group: 30 children without ADHD were enrolled in this case control study.Children were assessed by study tests: 1- Stanford Binet [fifth edition], 2- ADHD Test 3- REAL Scale, 4- Phonological Awareness Test, 5- Rapid Automatized Naming Test.Results: ADHD children were lower than their normal peers in IQ score, language skills, phonological awareness skills, and rapid automatized naming. Regarding aspects of language, they had defects in many skills: receptive and expressive vocabulary, morphosyntax, sentence comprehension, story comprehension, verbal categorization, sentence repetition, and forming sentences.

Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome is a rare Mullerian duct anomaly characterized by an obstructed hemivagina, ipsilateral renal agenesis, and uterine didelphys. There are only a few published case reports of OHVIRA syndrome, and cases of OHVIRA syndrome associated with cancer have rarely been reported. In fact, there is only one published report of a case with clear cell carcinoma (CCC) of the cervix. Here, we report a case of CCC of the cervix with OHVIRA syndrome that underwent abdominal radical hysterectomy; we also provide a short literature review of this topic. A 52-year-old woman presented with abnormal vaginal bleeding for 1 month 2 years after menopause. A pelvic examination and preoperative imaging showed uterine didelphys, an obstructed hemivagina with a mass measuring approximately 2 cm located in her left cervix, and an absence of her left kidney. A colposcopy biopsy reported CCC of the cervix. Clinical staging classified her with stage IB1 disease. Abdominal radical hysterectomy was performed. Her left ectopic ureter led to the left cervix and opened in the endometrium, resulting in a so-called ectopic ureter. Macroscopic examination of the excised specimens showed two cervixes, two corpora of the uterus, and a tumor measuring 1.0 × 2.0 cm on the left cervix. In addition to typical OHVIRA symptoms including uterine didelphys, obstructed hemivagina, and renal agenesis, several anatomical variants were present. The current case included those variants as well as an atrophic kidney with an ectopic ureter to the obstructed hemivagina. Based on the results of our case, clinicians should be aware of the risks of cancer and anatomical variants associated with OHVIRA syndrome.

The goal of this study is to describe the feeding behavior in children with autism spectrum disorders. Feeding problems may have a significant impact on the child’s growth, development, and opportunities for social and community participation. The MCH-Feeding Scale is an easy method that can be used for evaluation behavioral feeding problems. There is clear difference in the behavior feeding among ASD children and TD children. The MCH-Feeding Scale is an easy method that can be used for evaluation behavioral feeding problems.

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

Background Benign prostatic hyperplasia (BPH) is a common problem in aging males which has a potential impact on patients’ health-related quality of life. In the present prospective study, we evaluated the effect of adding solifenacin to tamsulosin, compared to tamsulosin alone on overactive bladder symptoms scores (OABSS) and patients’ quality of life (QoL) in patients with filling lower urinary tract symptoms due to BPH. Methods Patients included in our study were randomly assigned into 2 groups: group 1 included patients with BPH who received tamsulosin alone and group 2 included patients with BPH who received a combination of tamsulosin and sofinacin. Treatment period was 12 weeks in both groups. Quality of life and overactive bladder symptoms score questionnaires were obtained and compared in both groups before and after treatment. Results No significant differences were found between both groups before treatment. At the end of treatment period, The QoL score for Group 1 patients was significantly greater than the other group (mean rank was 138.98 in tamsulosin group versus 62.02 in the combination group, P-value P-value Conclusion Adding solifenacin to tamsulosin was associated with an improvement of QoL and OABSS in patients with irritative urinary symptoms due to BPH when compared with tamsulosin monotherapy.

This meta-analysis aims to compare Apert syndrome (AS) patients with non-AS populations (not clinically or genetically diagnosed) on craniofacial cephalometric characteristics (CCC) to combine publicly available scientific information while also improving the validity of primary study findings. A comprehensive search was performed in the following databases: PubMed, Google Scholar, Scopus, Medline, and Web of Science, an article published between 1st January 2000 to October 17th, 2021. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to carry out this systematic review. We used the PECO system to classify people with AS based on whether or not they had distinctive CCC compared to the non-AS population. Following are some examples of how PECO has been used: People with AS are labeled P; clinical or genetic diagnosis of AS is labeled E; individuals without AS are labeled C; CCC of AS are labeled O. Using the Newcastle–Ottawa Quality-Assessment-Scale, independent reviewers assessed the articles' methodological quality and extracted data. 13 studies were included in the systematic review. 8 out of 13 studies were score 7–8 in NOS scale, which indicated that most of the studies were medium to high qualities. Six case–control studies were analyzed for meta-analysis. Due to the wide range of variability in CCC, we were only able to include data from at least three previous studies. There was a statistically significant difference in N-S-PP (I2: 76.56%; P = 0.014; CI 1.27 to − 0.28) and Greater wing angle (I2: 79.07%; P = 0.008; CI 3.07–1.17) between AS and control subjects. Cleft palate, anterior open bite, crowding in the upper jaw, and hypodontia occurred more frequently among AS patients. Significant shortening of the mandibular width, height and length is the most reported feature in AS patients. CT scans can help patients with AS decide whether to pursue orthodontic treatment alone or to have their mouth surgically expanded. The role of well-informed orthodontic and maxillofacial practitioners is critical in preventing and rehabilitating oral health issues.

Candidacy evaluation for hypoglossal nerve stimulation (HGNS) is resource intensive. This proof-of-concept study investigates use of in-office volitional snore during flexible laryngoscopy as an efficient, cost-effective screening tool for HGNS evaluation. Adults with moderate to severe obstructive sleep apnea that failed continuous positive airway pressure treatment (n = 41) underwent evaluation for HGNS from 2018 to 2019. Volitional snore and drug-induced sleep endoscopy (DISE) data were collected and scored by VOTE classification (velum/palate, oropharynx, tongue base, epiglottis). A chi-square test of independence was performed that demonstrated a significant relationship between volitional snore and DISE (χ

AAbstract:Background: Zygomatic complex and arch fractures remain one of the most common maxillofacial fractures. Epidemiological studies of theses fractures vary by geographic region, socioeconomic, environmental and cultural factors. Its importance is confirmed by their implication in the clinical practice and prevention.Patients and Methods: Five-year retrospective study; from May 2015 to April 2020; was conducted on 120 patients with zygomatic fractures in our department. Fracture sites were classified into five types (I-V) based on the number of fractured processes and comminution. Data collected in a clinical sheet and analyzed using Statistical Package for Social Sciences version 20. P- value < 0.05 was considered significant. Chi square test was used to compare between 2 or more qualitative variables.Results: Patients aged from 15-78 years old and divided into 4 age groups (A-D). Group B (21- 40 years) was the commonest affected. Males were predominant than females with ratio M: F = (7:1). Motor car accidents was the commonest etiology of trauma (56.60%). Left sided fracture (52.5%) was involved more than right sided one (45%) and fracture was bilateral in 2.5% of cases. Type-IV fracture (classic tetrapod) was the commonest type reported (42 cases, 35 %). Most common fractured process was zygomatic-maxillary buttress (ZM) in 90 cases (75%). Mandibular fracture (15%) was the most common associated facial fractures. Most common accessed approach was the upper buccal in 80 cases (66.6 %). Access through a pre-existing wound was encountered in 10 cases (8.3 %). Four-point fixation (40%) was the commonest point fixation for these fractures. Infra orbital paresthesia (42 cases) was the most common complications encountered.Conclusion: Zygomatic fractures have high morbidity and cost of life. Use of protective devices, strict laws and severe punishments must be implemented to reduce its frequency.

Background: Heart failure is a common cause of morbidity and mortality in pediatric patients in the third world. Heart failure in children occurs due to heart lesions that cause volume overload as in large ventricular septal defect or due to lesions that causes obstruction to flow as in aortic stenosis. Objective: This study aimed to evaluate the neutrophils to lymphocytes ratio in children with heart failure & to investigate if this ratio is helpful in predicting mortality and adverse outcome in those patients. Patients and methods: Our study was performed over a number of 80 children 40 of them were having CHD with acute heart failure, 20 of them were congenital heart disease (CHD) without failure and 20 of them were normal. The was conducted in Pediatric Cardiology Unit and Pediatric ICU, Zagazig University Children Hospitals during the period from February 2017 till May 2018. Results: Our present work showed that neutrophils, CRP and NLR were statistically higher in the Heart failure group compared to cardiac group and control group. While lymphocytes and oxygen saturation (SO2) were statistically lower in the heart failure group. The echocardiographic findings showed that compared to cardiac group, the heart failure group was significantly higher regarding PAP and LVEDD but significantly lower regarding EF and FS. Conclusion: Elevated NLR seems to be a predictor of short-term mortality in patients with acute heart failure.

Young working adults frequently suffer from tendon injuries. However, despite the many advancements in repair techniques and postoperative physiotherapy programs that improved recovery, the benefit of fat injections in improving the outcome through their regenerative properties has remained under trial. A total of 50 patients with isolated flexor tendon injuries (zone II) presenting to the Emergency Department of Cairo University Hospitals from June 2018 to June 2019 were included and randomly divided into two groups. Group A cases received conventional tendon repair techniques without fat injection, whereas group B received fat injection as an adjunctive procedure after conventional repair. The outcomes were recorded and statistically analyzed. Patients mean age was 25 years (range 17–50, standard deviation (SD) 2.4). The median for TAM (total active motion) in group A was 120 and 170, pre- and postoperatively. For group B, the median for TAM was 125 and 180, pre- and postoperatively. A comparison between both groups showed that group B had a higher postoperative median for TAM than group A (p

A hallmark of metastasis is the adaptation of tumor cells to new environments. Metabolic constraints imposed by the serine and glycine–limited brain environment restrict metastatic tumor growth. How brain metastases overcome these growth-prohibitive conditions is poorly understood. Here, we demonstrate that 3-phosphoglycerate dehydrogenase (PHGDH), which catalyzes the rate-limiting step of glucose-derived serine synthesis, is a major determinant of brain metastasis in multiple human cancer types and preclinical models. Enhanced serine synthesis proved important for nucleotide production and cell proliferation in highly aggressive brain metastatic cells. In vivo, genetic suppression and pharmacologic inhibition of PHGDH attenuated brain metastasis, but not extracranial tumor growth, and improved overall survival in mice. These results reveal that extracellular amino acid availability determines serine synthesis pathway dependence, and suggest that PHGDH inhibitors may be useful in the treatment of brain metastasis. Significance: Using proteomics, metabolomics, and multiple brain metastasis models, we demonstrate that the nutrient-limited environment of the brain potentiates brain metastasis susceptibility to serine synthesis inhibition. These findings underscore the importance of studying cancer metabolism in physiologically relevant contexts, and provide a rationale for using PHGDH inhibitors to treat brain metastasis. This article is highlighted in the In This Issue feature, p. 1241

This study aimed to investigate the intra- and interovarian relationships among the corpus luteum (CL), the largest follicle (LF) and follicular population in non-pregnant and between the conceptus and ovarian structures in pregnant ewes. In experiment 1, the follicular and luteal structures were examined in 538 reproductive systems of non-pregnant Awassi ewes. The follicular population was categorised into small (SF), medium (MF) and large (LF) groups. Inter-relationships between CL and follicular population and between LF and subordinate follicles were determined. In experiment 2, the location and number of conceptuses were identified and correlated with the ovarian structures in 58 reproductive systems of pregnant ewes. Effects of pregnancy status, stage of pregnancy, pregnancy side and conceptual number on follicular population were determined. The results showed that the right ovary was more active than the left ovary. CL had intraovarian positive effect on the number of medium and large follicles. LF had no local suppressive effect on the subordinate follicles. Side and stage of pregnancy and the conceptual number did not affect the follicular population. Accordingly, it can be concluded that the LF has no local suppressive effect on the subordinate follicles. The CL has intraovarian positive effect on the follicular population. Follicular population does not show remarkable changes during the first term of pregnancy. The present study probably provides information which may help in the understanding of the ovarian dynamics during pregnancy in sheep.

There is an unmet need and urgency to find safe and effective anti-obesity interventions. Our recent study in mice fed on obesogenic diet found that treatment with the alcohol aversive drug disulfiram reduced feeding efficiency and led to a decrease in body weight and an increase in energy expenditure. The intervention with disulfiram improved glucose tolerance and insulin sensitivity, and mitigated metabolic dysfunctions in various organs through poorly defined mechanisms. Here, integrated analysis of transcriptomic and proteomic data from mouse and rat livers unveiled comparable signatures in response to disulfiram, revealing pathways associated with lipid and energy metabolism, redox, and detoxification. In cell culture, disulfiram was found to be a potent activator of autophagy, the malfunctioning of which has negative consequences on metabolic regulation. Thus, repurposing disulfiram may represent a potent strategy to combat obesity.

Background: Impairment of the facial nerve functions, after cerebellopontine angle surgery is a common complication that limits the quality of life. Appropriate preoperative planning with a visualization of the facial nerve is a vital tool for the proper management of this disease. Objective: To discuss retrospectively and introspectively, the different modalities helping in preservation the facial nerve during cerebellopontine angle surgeries, and to evaluate the outcome of the usage of these modalities. Patients and Methods: A total of 30 cases with cerebellopontine angle lesions, who had surgical excision of these lesions, performed by different surgical procedure, with preservation of facial nerve function. They were operated upon in Neurosurgery Department at Al-Azhar University Hospitals and Nasser Institute Hospital, during the period between November 2017 and November 2019. Results: One patient had a CSF leak that was temporarily, one patient had postoperative hydrocephalus that was treated with external ventricular drain, and one patient had small sized intracranial hemorrhage resolved spontaneously and did not need any intervention. The remaining 27 patients have improvement of symptoms and signs at follow up periods of 3, 6, 12 months. Conclusion: Preservation of the facial nerve, during cerebellopontine angle surgeries, can be done altogether with total removal of the tumor in one session, by usage of microscopic surgical procedures altogether with intraoperative neurophysiological monitoring. Facial nerve preservation is a safe procedure.

Background: Heart failure is one of the cardiovascular diseases that have high morbidity and mortality especially among children. It accounts for 2% of all pediatric inpatient admission. Cardiac Myosin Binding Protein-C (cMyBP-C) is cardiomyocyte specific sarcomeric protein that regulates sarcomeric structure and its function where it is released in circulation in response to cardiac injury. Objective: To explore the role of cMyBP-C as a biomarker in heart failure in children. Patients and Methods: This prospective cohort study was carried out during the period from October 2017 to October 2018 in Pediatric Cardiology Unit, Zagazig University Hospital. It included 26 selected patients with heart failure diagnosed clinically and by echocardiography. Results: The study revealed that the most common cause pf heart failure in our patients was VSD (30.8%) then DCM (26.9%). 57.7% of studied patients were grade III of ROSS classification while 30.8% were grade IV and 11.5% were grade II. In ECHO findings, mean EF% was 52.3% while mean FS% was 33 % with negative correlation between plasma level of cMyBP-C and EF% and FS%. There was high statistical significant difference in cMyBP-C plasma level at time of admission and after treatment (123.5 ng/ml and 78.8 ng/ml respectively). There was high statistical significant difference in level of cMyBP-C among improved cases before and after treatment. There was no statistical significant difference in level of cMyBP-C before and after treatment among cases with bad prognosis. Conclusion: cMyBP-C could be a prognostic biomarker in children with HF and may be used as a tool to help in HF diagnosis in children as a marker of disease severity.

The objective of this study was to compare the effects of synthesized nano-selenium (NS) and commercial inorganic selenium (Se) on immunity, behaviour, and performance of Arbor (AB) and Ross (RB) broilers that were exposed to heat stress of 40 °C for 6 - 8 hours daily over 38 days. Two hundred and ten one-day-old broilers of two breeds were supplemented with 0.5 mL/L of NS or Se in their drinking water. Two hundred sera, 200 intestinal swabs, and 1000 internal organ and tissue samples were collected. Weight gain, performance index, behavioral indices, total antioxidant capacity, malondialdehyde, superoxide dismutase, immunoglobulin G, immunoglobulin M, serum total protein, albumin, alanine aminotransferase, aspartate aminotransferase, and serum creatinine concentrations increased (P

Background: Patients with type 2 diabetes are at signifi-cantly increased risk for cardiovascular morbidity and mortality compared with age-matched healthy control subjects. Aim of Study: Was to determine the effect of high intensity interval training on blood glucose levels in type 2 diabetes. Subject and Methods: Forty diabetic patients of both sexes (12 males and 28 females). They were assigned into two groups equal in number. All patients were diagnosed clinically with established T2DM for more than 7-year duration. Their ages ranged from 45 to 55 years selected from outpatient clinic of Kasr El-Aini, Cairo University, Egypt. Study group with mean age (51.07±3.31) years. and Control group with mean age (51.36± 2.83 ) years. The study group included 20 patients (7 males and 13 females) who practiced high intensity interval training at intensity level of (85-90% of MHR), three times per week for 12 weeks in addition to their optimized oral hypoglycemic medications. Symptom limited exercise test was performed before and after training (12 weeks) to determine maximum heart rate. The control group included 20 patients (5 males 15 females) who only received their optimized oral hypoglycemic medications. Fasting and post prandial blood glucose were measured initially before starting the treatment and after the end of the sessions in both groups. Results: Post-treatment there were a significant improve-ment in both fating and two hours post prandial blood glucose. There were a significant decrease in fasting and two hours post prandial blood glucose. Conclusion: The high intensity interval training is an effective tool to decrease insulin resistance and hyperglycemia this effect is mediated, in part, by the decrease in fasting and two hours post prandial blood glucose in type 2 diabetic patients which consequently helps in the treatment type 2 diabetes.

Background: Traumatic brain injury remains a major cause of death and disability all over the world. In Egypt it represents a major public health problem, representing 17.2% of trauma patients. Various factors determine the prognosis after TBI, the primary insult, which is irreversible and the secondary insults which continue to evolve during the subse-quent period after trauma. Aim of Study: In this study, we examined the value of immediate post-operative head CT scans in trauma patients to assess its efficacy and role in returning back to operation room. Results: We prospectively studied 145 patients with head injury who underwent surgery at Kasr Al-Ainy Hospitals during a period of 4 months between 10/2018 and 1/2019. All patients had immediate follow-up CT within 2 hours and another follow-up within 48 hours. The results of the immediate CT were: 121 cases improved (83.4%), expected worsening in 14 patients (9.7%) out of which 5 patients had redo surgery, unexpected worsening in 8 patients (5.5%) out of which 2 patients had redo surgery and 2 patients with unexpected new fining (none of them required redo). The 48 hours CT revealed no change in 133 patients (91.%), unexpected new finding in 12 patients (8.3%) most of these changes were in patients with ASDH. Conclusion: Unexpected change in the neurological ex-amination was the single most influential factor in determining the need for redo surgery. The low-cost, meticulous neurolog-ical examination appears to be superior to a routine CT scan in determining return to the operation room.

Background: Intracerebral hematoma affects about 2.5 per 10,000 people each year. The incidence is more in males and older people. The mortality rate is about 44% in the first month. 20% of cases has a good outcome. Symptoms can include headache, one-sided weakness, vomiting, seizures, decreased level of consciousness, and neck stiffness. Often symptoms get worse over time. In many cases bleeding occurs in the brain tissue and the ventricles at the same time. Many procedures and techniques have been introduced for the management of intracerebral hematoma and debate always exist about the management of sizable intracerebral hematomas especially if the conscious level isn't markedly affected. Aim of Study: To evaluate the role of early evacuation of sizable intracerebral hematomas even if the conscious level isn't markedly deteriorated. Method: This is a retrospective study of 30 cases of intracerebral hematoma operated in Kasr El-Aini Hospitals and Bani Suef University Hospitals by evacuation assisted by microscope with a Glasgow Coma Scale more than 10 in most cases with a sizable intracerebral haemorrhage more than 30cc in the volume. Results: This study results was 22 (73%) male patients and 8 (27%) was female patients. The age group was 4 patients (13%) under 30 years, 22 patients (73%) were from 30-45 years and 4 patients (13%) were more than 45 years old. The Glasgow Coma Scale (GCS) on admission was 14-15 in 4 patients (13%) patients, from 10-13 was 14 patients (46%), and from 9 and less was 12 patients (41%). 20 patients (67%) case was diabetics, 23 patients (46%) cases was hypertensive, 2 patients (7%) had chronic renal failure on regular dialysis, 1 patient (3%) case was pregnant. The GCS post-operative was 14-15 in 20 patients (70%), 10-13 in 5 patients (16%), and from 9 and less in 5 (24%) cases. The operation done was evacuation in all cases, decompressive craniectomy in 8 patients (26%), ventriculosubgaleal shunt done (VSG) in 3 patients (10%). The side of the hematoma was left sided in 7 patients (24%), right in 23 patients (76%). Good out come in 25 cases (83%), recollection in 3 (10%) cases, residual hematoma in 2 (6%) of the cases, re evacuation done in 1 patient (3%). Mortality were 4 patients.Conclusion: Sizable intracerebral hematoma (volume more than 30cc) in good Glasgow coma scale mostly obeying orders, spontaneous eye opening, and aphasic or not, to obtain a good outcome is to evacuate the hematoma not to wait for conservative management.

Background: The understanding of what mothers think about breastfeeding helps in developing successful breastfeeding promotion programs. This study aims to assess the maternal knowledge, attitude, and practice about the complementary feeding for infants aged 6-12 months. Methods: A cross-sectional study designed to interview 219 mothers with children between 6-12 months. Data was collected between 1st March and 30th April 2019 from ten maternal and child health clinics (MCHCs) in Anbar Province, Iraq. SPSS version 16.0 was recruited to analyze the data. Descriptive and inferential statistics such as Chi-square used to present data with the significance level set at less than 0.05. Results: The mean age of respondents was 27.76 ± 6.3 years, and 31% were at the primary school level. Two third (66.82%) of the surveyed mothers exclusively used breastfeeding to feed their infants. Most women (84.09%) have the correct knowledge about the best time to start complementary food. The vast majority of women (93.64%) refused to give vitamins to children even with signs of malnutrition. Conclusion: Although exclusive breastfeeding is common among mothers of the western region in Iraq, there is still a considerable percentage depend on the mixture of breastfeeding and bottle feeding. The positive impact of the family and society on mothers was evident. However, more attention should be given to improve knowledge, attitude, and practice through qualified healthcare providers.

Epstein-Barr virus (EBV) is prevalent among healthy individuals, and is implicated in numerous reactive and neoplastic processes in the immune system. The authors originally identified a series of senile or age-related EBV-associated B-cell lymphoproliferative disorders (LPD) bearing a resemblance to immunodeficiency-associated ones. These LPDs may be associated with immune senescence and are now incorporated into the revised 4th edition of 2017 WHO lymphoma classification as EBV-positive (EBV+) diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS). These EBV+ B-cells often have a Hodgkin/Reed-Sternberg (HRS)-like appearance and are shared beyond the diagnostic categories of mature B-cell neoplasms, mature T-cell neoplasms, classic Hodgkin lymphoma, and immunodeficiency-associated LPD. In addition, peculiar new diseases, such as EBV+ mucocutaneous ulcer and EBV+ DLBCL affecting the young, were recognized. On the other hand, lymphoma classification is now evolving in accord with deeper understanding of the biology of programmed death ligand 1 (PD-L1). Assessing PD-L1 positivity by staining with the anti-PD-L1 monoclonal antibody SP142 provides new insight by discriminating between immune evasion and senescence or immunodeficiency. The aim of the present review is to briefly summarize the diagnostic use of immunostaining with SP142 in malignant lymphomas and/or LPDs that feature tumor and nonmalignant large B-cells harboring EBV.

Background No data are available on incidence, surgical approaches, complications, and survival for patients with infratentorial meningiomas in developing countries. Predictors for surgical resection, recurrence, and complications were analyzed based on the surgical outcomes of patients with infratentorial meningiomas. Methods A total of 101 consecutive cases of infratentorial meningiomas operated on between April 2012 and April 2017 at our institute were reviewed retrospectively. The patients had a mean age of 55.1 ± 5 years, a female predominance of 62.3%, and the mean duration of follow-up duration was 44.2 ± 15.5 months. Results The most common surgical approach was retrosigmoid (n = 51) followed by suboccipital (n = 36), subtemporal (n = 8), and far lateral (n = 6). The preoperative presentation showed that affected cranial nerve was the most common presenting symptom (47.5%) followed by weakness (24.8%) and affected vision (16.8%) followed by headache (8.9%) and gait disturbance (6.9%). The extent of resection was grade I (n = 63), grade II (n = 15)and grade III (n = 23) according to the Simpson grading. The complication rate was 56 cases (55.4%); the most common complication was cranial nerve palsy (42.6%), followed by weakness (31.7%), hydrocephalus (16.8%), chest infection (8.9%), ataxia (4%), deep venous thrombosis (4%), cerebrospinal fluid leak (3%) and meningitis and pulmonary embolism (both 1%). Conclusions The location, surgical approach, preoperative Karnofsky Performance Status, and peritumor edema were significantly associated with complications. Compared with developed countries, we had a higher complication rate (P