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Background: Improving recovery after exercise is vital for decreasing cardiac mortality by dominance of parasympathetic nervous system control in recovery time. Objective: To determine the influence of coronary artery disease on heart rate recovery after exercise in patients with diabetes mellitus. Patients and Methods: The ethical approval was obtained from the hospital ethical research committee, in cardiology department in Al-Hussein university hospital from March 2019 to November 2019 and each patient signed an informed consent. Fifty patients were included in this study divided in 4 groups, all with no evident history of ischemic heart disease. Detailed history, physical examination, resting ECG, trans thoracic echocardiography, and finally treadmill exercise stress test was done. In this study we assessed heart rate recovery in 1st, 2nd& 3rd minute and also basal heart rate included. Results: Significant delay in heart rate recovery time was detected in diabetic patients with positive stress ECG test for myocardial included ischemia. Conclusion: Delayed recovery and reduced heart rate recovery after treadmill exercise stress test is an available and important index for detecting and revealing the extent of ischemic burden.

Purpose The main aim of the study was to report visual, refractive, topographic, and aberrometric results of accelerated CXL in patients with keratoconus who were followed for 12 months and to highlight the important parameters that can be used in follow-up. Settings It was a prospective interventional non-randomized case series study, in which 40 keratoconus eyes of 40 patients were studied in the period between April 2016 and July 2018. Methods All eyes were examined preoperatively and post-accelerated CXL to evaluate visual acuity, refractive state, keratometric values, keratoconus indices, and corneal higher order aberrations (HOAs). Results The mean age of the studied patients was 28.4 ± 8.6 years (18-37years). One year after cross-linking, 11.6% of the eyes gained two lines of the UCVA, 26.4% of the eyes gained one line, 49.8% showed no change, 7.1% lost one line, and 5.1% lost two lines. Postoperative BCVA showed 13.7% of the eyes gained at least two lines, 32.5% gained one line, 49.9% had no change, and 3.9% lost one line. The keratometric values changed significantly after CXL; K1 decreased by a mean of 0.41D, K2 by 0.62D while Kmax by 1.57 D. The significant changes in keratoconus indices were in index of vertical asymmetry (IVA), index of surface variance (ISV), and keratoconus index (KI). Vertical coma, spherical aberrations, and trefoil decreased significantly at 12 months compared to baseline values (p = 0.04, 0.017, 0.025, respectively). Conclusion Keratoconus indices especially ISV, IVA, and KI along with HOAsparticularly vertical coma, spherical aberrations, and trefoil can add value beside keratometric readings in the follow-up of eyes treated with accelerated CXL.

Background Patients with schizophrenia suffer from diffuse cognitive impairment and high prevalence of cardiovascular metabolic risks, associated with poor clinical outcomes. We aimed in this study to test the presence of cognitive impairment in a sample of patients with schizophrenia, and evaluate its possible relations to patients’ metabolic profile. We recruited forty patients diagnosed with schizophrenia and their matched controls from the inpatient departments and outpatient services from January to December 2016. Schizophrenia diagnosis was confirmed by the ICD10 criteria checklist. Symptoms profile and severity were assessed by the Positive and Negative Syndrome Scale. Cognitive profile was assessed through (1) Trail Making Test, Parts A and B and (2) Wechsler Memory Scale-Revised Visual Reproduction Test. Metabolic profile was assessed by measuring the body mass index, fasting blood glucose, and lipid profile. SPSS (V. 22.0, IBM Corp., USA, 2013) was used for data analysis. Results The patients group had a significantly higher means in the speed of processing, executive function, attention, and working memory scores on TMT-A (p = 0.0), TMT-B (p = 0.00), and WMS-R (p = 0.029) and significantly higher FBG levels (p = 0.00). Correlation studies showed that the increase in patients’ age, illness duration, treatments, number of hospitalizations, number of episodes and of ECT sessions received, symptoms severity, and deficits in cognitive function scores was associated with higher BMI and FBG. Conclusions Patients with schizophrenia have a higher prevalence of cognitive impairment and vascular risk factors than the general population. Close monitoring and early management of these risk factors can promote better cognitive abilities and overall functions.

Mahmoud Mohamed Genaidy, Hosny Ahmed Zein, Ahmed Mostafa Eid Department of Ophthalmology, Faculty of Medicine, Minia University, Minia, Egypt Purpose of the study: To evaluate efficacy, safety, and success rates of canaloplasty combined with phacoemulsification and intraocular lens implantation in patients with open-angle glaucoma (OAG) and visually significant cataract.Patients and methods: A prospective interventional noncomparative case series carried out in Minia University Hospital from April 2015 to October 2016 on 20 eyes of 18 patients who had visually significant cataract and primary OAG. All the cases had combined phacocanaloplasty. Preoperative best-corrected visual acuity, intraocular pressure (IOP), and number of antiglaucoma medications were collected and compared to postoperative levels, and complications rates were recorded.Results: 20 eyes of 18 patients (5 males and 15 females), with a mean age 57.6 years (range 48–69years), underwent phacocanaloplasty. Preoperative mean IOP was 25.20 ±1.009mmHg. Postoperative IOP decreased to a mean of 14.20±0.9, 14.85±0.8, and 15.85±0.7 mmHG at 3, 6, and 12months, respectively, with 37% reduction from preoperative IOP level at one year follow-up visit (P=0.0005). The number of antiglaucoma medications dropped from mean of 1.55 preoperatively to 0.35 postoperatively. LogMAR of best-corrected visual acuity improved from 0.6950±0.07 preoperatively to 0.3670±0.056, 0.3460±0.056, and 0.03370±0.052 at 3, 6, and 12months postoperatively (P=0.0005). Complications were limited to mild hyphemia (one case), mild corneal edema (one case), and mild inflammatory membrane (one case) that resolved in the first week after surgery.Conclusion: Canaloplasty combined with clear corneal phacoemulsification and intraocular lens implantation may be a safe and effective procedure to lower IOP in adult patients with OAG and visually significant cataract. Keywords: cataract, glaucoma, phacoemulsification, canaloplasty

Background Middle East respiratory syndrome (MERS) is caused by a coronavirus (MERS‐CoV) and is characterized by hypoxemic respiratory failure. The objective of this study is to compare the outcomes of MERS-CoV patients before and after the availability of extracorporeal membrane oxygenation (ECMO) as a rescue therapy in severely hypoxemic patients who failed conventional strategies. Methods We collected data retrospectively on MERS-CoV patients with refractory respiratory failure from April 2014 to December 2015 in 5 intensive care units (ICUs) in Saudi Arabia. Patients were classified into two groups: ECMO versus conventional therapy. Our primary outcome was in-hospital mortality; secondary outcomes included ICU and hospital length of stay. Results Thirty-five patients were included; 17 received ECMO and 18 received conventional therapy. Both groups had similar baseline characteristics. The ECMO group had lower in-hospital mortality (65 vs. 100%, P = 0.02), longer ICU stay (median 25 vs. 8 days, respectively, P

Anemia is one of the most common public health problems in the world, especially among pregnant women. The objective of our study is to describe the socio-demographic and epidemiological profile of anemic women. We conducted a prospective study in the maternity department of the CHEIKH ZAYED Hospital Center in Nouakchott, during the period from 2015 to 2016. In addition, 400 pregnant women are interviewed, including 49.75% (n=199) with anemia, of which 34.17% were under 24 years of age, 63.31% are white Moors and 90.45% are at home. As a result, Statistical analyzes show a significant relationship, between certain socio-economic factors (Age, provenence area, ethnic origin, household size) and anemia.

Post-operative recurrence in mycetoma after adequate medical and surgical treatment is common and a serious problem. It has health, socio-economic and psychological detrimental effects on patients and families. It is with this in mind, we set out to determine the predictors of post-operative recurrence in mycetoma. The study included 1013 patients with Madurella mycetomatis causing eumycetoma who underwent surgical excision at the Mycetoma Research Centre, Khartoum, Sudan in the period 1991–2015. The clinical records of these patients were reviewed and relevant information was collected using a pre-designed data collection sheet. The study showed, 276 patients (27.2%) of the studied population developed post-operative recurrence, 217 were males (78.6%) and 59 were females (21.4%). Their age ranged between 5 to 70 years with a mean of 32 years. The disease duration at presentation ranged between 2 months and 17 years. The majority of the patients 118 (42.8%) had mycetoma of 1 year duration. In this study, students were the most affected; 105 (38%) followed by workers 70 (25.4%), then farmers 48(17.3%). The majority of the patients were from the Central Sudan 207 (75%), Western Sudan 53 (19.2%) while 11 patients (4%) were from the Northern part. Past history of surgical intervention performed elsewhere was reported in 196 patients (71.1%). Family history of mycetoma was reported in 50 patients (18.1%). The foot was the most affected site, 245 (88.7%), followed by the hand seen in 19 (6.8%) patients and 44 (4.5%) had different sites involvement. Most of the patients 258 (93.5%) had wide local surgical excisions while 18 had major amputation. The model predicted that the certain groups have a high risk of recurrence, and these include patients with disease duration greater than 10 years and extra-pedal mycetoma. Patients with disease duration between [5–10] years, with pedal mycetoma, who had previous surgery, with positive family history and underwent wide local surgical excision. Patients with disease duration [5–10] years, with pedal mycetoma, had previous surgery, with no family history but presented with a disease size (> 10 cm), were non- farmers and underwent wide local surgical excision. Other groups are patients with disease duration (≤5 years), with pedal mycetoma, age 10 cm, working as farmers or students and underwent wide local surgical excision. In conclusion, these groups of patients need special care to reduce the incidence of post-operative recurrence with its morbidity and detrimental consequences. In depth studies for the other predisposing factors for post-operative recurrence such as genetic, immunological and environmental factors are needed., Author Summary Post-operative recurrence in mycetoma is a thoughtful problem. It has numerous undesirable medical, health, socio-economic and psychological impacts on the affected patients and their families, communities and health authorities in endemic regions. It is an important motive for patients to drop out follow up and treatment incompliance and hence the inclination of patients for traditional medical treatment. The factors predicating this phenomenon were not studied previously. However, patients’ characteristics and clinical presentation can partially offer an explanation. Thus the present study was set out to understand the predictive ability of some clinical factors on predicting the post-operative recurrence of eumycetoma. The present study had showed young farmers with small sized pedal mycetoma, with short disease duration, who are residing in endemic areas, with no family history and who underwent wide local excision are most likely to remain disease free. We can also concluded that, adequate surgical treatment conditions are obligatory to achieve good outcome and to reduce recurrence. Appropriate health education programmes to encourage early presentation to medical care are essential to reduce the postoperative recurrence rate with its detrimental impacts.

Lathyrism is a disorder of the central motor system, induced by heavy consumption of the grass-pea, Lathyrus sativus an environmentally tolerant legume containing the neurotoxic excitatory amino acid beta-N-oxalylamino-L-alanine (BOAA). A complete door-to-door resurvey of the Dembia and Fogera regions of northwestern Ethiopia, areas endemic for lathyrism, revealed an estimated mean disease prevalence of 0.6%-2.9%. Most patients developed the disease in the epidemic of 1976/77, although new cases appear to have occurred with an estimated mean annual incidence of 1.7:10,000. Production and consumption of grass-pea is increasing in Ethiopia, making attempts to develop low-BOAA strains to prevent lathyrism increasingly important.

Foreword Preface General Works Infectious Diseases Food, Malnutrition and Nutrition Rehabilitation Non-Infectious Diseases Mother and Child Health Accidents, Injuries, Poisoning, and Intoxication Mental Health Health Services Traditional Medicine Famine, Resettlement and Refugees Author Index Subject Index

The prevalence and intensity of Schistosoma mansoni infections were studied in 3 endemic communities in north-western Ethiopia using the Kato-Katz stool examination technique to determine changes in the epidemiology of schistosomiasis in the absence of control programmes. The prevalence declined in Chwahit community by 21.6%, and in the villages of Jenda and Guramba by 43.2 and 100% respectively in the course of 15 years. This spontaneous reduction in schistosomiasis is perhaps the result of recurrent drought in the area. This finding has implications for public health programmes in the area and intervention measures against schistosomiasis.

The charts of 132 louse-borne relapsing fever (LBRF) patients admitted to a teaching and provincial hospital in Northwestern Ethiopia covering the period 1970-1985 were analysed. Of the 83 males (62.9%) and 49 (37.1%) females, there were 97 patients treated with varying doses of intramuscular procaine penicillin (100,000-600,000 u) as well as a group of 35 patients treated with single or multiple doses of tetracycline. The average age of tetracycline-treated and penicillin-treated groups was similar, but 65.7% of the former group were above 20 years of age while 51.6% of the latter group were above 20 years of age. The overall rate of the Jarisch-Herxheimer (J-HR) reaction was 21.2%. The corresponding rates in penicillin- and tetracycline-treated groups were 24.7% and 11.4% respectively. Although the frequency of the J-HR reaction is twice as large in the penicillin-treated group as compared with the tetracycline- treated group, the difference is not statistically significant (P>0.05). Similarly the overall death rate following antibiotic treatment was 3.8%. In terms of the J-HR reaction, there were more deaths in the penicillin-treated group (4.1 %), with 2.8% in the tetracycline group. In terms of the frequency as well as mortality from the J-HR reaction, it appeared that penicillin had no therapeutic advantage over tetracycline, and the latter was associated with less frequent J-HR reaction and death. These findings are in contrast to the preference for penicillin in the treatment of hospitalized LBRF patients in Ethiopia at present. As there is no concensus on the treatment of LBRF, a multicentre trial involving older and more recent antibiotics is recommended.