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Antibody tests for SARS-CoV-2, the virus that causes COVID-19, are widely available. These practice points help clinicians, patients, and public health professionals understand how to use and interpret these results on the basis of the available evidence. The practice points will be updated as more evidence becomes available., Description: The widespread availability of SARS-CoV-2 antibody tests raises important questions for clinicians, patients, and public health professionals related to the appropriate use and interpretation of these tests. The Scientific Medical Policy Committee (SMPC) of the American College of Physicians developed these rapid, living practice points to summarize the current and best available evidence on the antibody response to SARS-CoV-2 infection, antibody durability after initial infection with SARS-CoV-2, and antibody protection against reinfection with SARS-CoV-2. Methods: The SMPC developed these rapid, living practice points based on a rapid and living systematic evidence review done by the Portland VA Research Foundation and funded by the Agency for Healthcare Research and Quality. Ongoing literature surveillance is planned through December 2021. When new studies are identified and a full update of the evidence review is published, the SMPC will assess the new evidence and any effect on the practice points. Practice Points: Practice Point 1: Do not use SARS-CoV-2 antibody tests for the diagnosis of SARS-CoV-2 infection. Practice Point 2: Antibody tests can be useful for the purpose of estimating community prevalence of SARS-CoV-2 infection. Practice Point 3: Current evidence is uncertain to predict presence, level, or durability of natural immunity conferred by SARS-CoV-2 antibodies against reinfection (after SARS-CoV-2 infection).

Context The growing number of systematic reviews/meta-analyses (SR/MAs) on vitamin D (± calcium) for fracture prevention has led to contradictory guidelines. Objective This umbrella review aims to assess the quality and explore the reasons for the discrepancy of SR/MAs of trials on vitamin D supplementation for fracture risk reduction in adults. Methods We searched 4 databases (2010-2020), Epistemonikos, and references of included SRs/MAs, and we contacted experts in the field. We used A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR-2) for quality assessment. We compared results and investigated reasons for discordance using matrices and subgroup analyses (PROSPERO registration: CRD42019129540). We included 13 SR/MAs on vitamin D and calcium (Ca/D) and 19 SR/MAs on vitamin D alone, compared to placebo/control. Results Only 2 from 10 SRs/MAs on Ca/D were of moderate quality. Ca/D reduced the risk of hip fractures in 8 of 12 SRs/MAs (relative risk [RR] 0.61-0.84), and any fractures in 7 of 11 SR/MAs (RR 0.74-0.95). No fracture risk reduction was noted in SRs/MAs exclusively evaluating community-dwelling individuals or in those on vitamin D alone compared to placebo/control. Discordance in results between SRs/MAs stems from inclusion of different trials, related to search periods and eligibility criteria, and varying methodology (using intention to treat, per-protocol, or complete case analysis from individual trials). Conclusion Ca/D reduces the risk of hip and any fractures, possibly driven by findings from institutionalized individuals. Individual participant data meta-analyses of patients on Ca/D with sufficient follow-up periods, and subgroup analyses, would unravel determinants for a beneficial response to supplementation.

BACKGROUND: CD10 and CD15 expression has been reported in several tumors. Whether CD10 and CD15 have a role in colorectal mucinous and signet ring adenocarcinoma (MSA) tumorigenesis is not yet known. OBJECTIVE: We aimed to investigate the role of CD10 and CD15 expression in mucinous colorectal adenoma-carcinoma sequence (ACS) and determine if there is any clinical and prognostic significance associated with their expression. METHODS: Seventy-five cases of colorectal MSA, and 9 cases of adenoma samples were collected. Manual TMA blocks were constructed and immunohistochemistry for CD10 and CD15 was done. RESULTS: Compared to adenomas, CD15 expression was significantly higher in MSA (p= 0.002), in contrast to CD10 expression. CD15 positivity was significantly associated with microsatellite stable (MSS) tumors (p= 0.018). The association between CD10 positivity and fungating tumor growth showed marginal significance. Unlike CD10, CD15 positivity showed significant association with overall survival of colorectal MSA patients. CONCLUSIONS: CD15 expression seems to have a role in mucinous colorectal ACS, with significant impact on the survival of MSA patients. Further studies are suggested to identify any genetic alterations that may underlie a potential association with disease progression.

To report the outcome of unsedated office based Thulium laser therapy for Reinke's edema.A retrospective chart review of patients operated between March 2017 and November 2018 was conducted. Twelve patients were included, two of whom had two procedures performed. Demographic data included age, gender, smoking status, and grade of Reinke's edema. Outcome measures included Voice Handicap Index-10 (VHI), perceptual evaluation, extent of disease regression, acoustic analysis, and maximal phonation time.Twelve patients were enrolled in this study, one of whom was lost for follow-up. There were eight females and three males. The mean age was 51.27 ± 9.12 years. Endoscopic evaluation 6-12 weeks after surgery revealed complete and partial regression of disease in three and eight patients, respectively. There was a significant improvement in the mean score of VHI-10 (15.00 ± 9.45 vs 3.07 ± 3.81) and the mean score of GRABS parameters following surgery (P0.05). The mean habitual pitch increased from 125.11 ± 28.48 Hz to 155.86 ± 55.14 Hz (P = 0.070). There was improvement in the mean jitter and shimmer but none reached a statistical significance. There was no significant change in the mean Maximum phonation time (MPT) scores before and after surgery.Unsedated office-based Thulium laser therapy can be considered as an alternative therapy to patients with Reinke's edema who are not willing to undergo conventional microlaryngeal surgery.

Objective The goal of this study was to develop an approach that can be used where baseline risk estimates that are directly applicable to prioritized patient-important outcomes are not available from published studies. Study design The McMaster University GRADE Centre and the ASH guideline panel for the prevention of VTE in surgical patients developed a modeling approach based on explicit assumptions about the distribution of symptoms, anatomical location, and severity of VTE events. Results We applied the approach to derive modeled estimates of baseline risk. These estimates were used to calculated absolute measures of anticipated effects that informed the discussion of the evidence and the formulation of 30 guideline recommendations. Conclusion Our approach can assist guideline developers facing a lack of information about baseline risk estimates that directly apply to outcomes of interest. The use of modeled estimates increases transparency in the process and makes the baseline risk used by guideline experts explicit during their decision-making.

Background Immune-based therapies are standard-of-care treatment for coronavirus disease 2019 (COVID-19) patients requiring hospitalization. However, safety concerns related to the potential risk of secondary infections may limit their use. Methods We searched OVID Medline, Ovid EMBASE, SCOPUS, Cochrane Library, clinicaltrials.gov, and PROSPERO in October 2020 and updated the search in November 2021. We included randomized controlled trials (RCTs). Pairs of reviewers screened abstracts and full studies and extracted data in an independent manner. We used RevMan to conduct a meta-analysis using random-effects models to calculate the pooled risk ratio (RR) and 95% CI for the incidence of infection. Statistical heterogeneity was determined using the I2 statistic. We assessed risk of bias for all studies and rated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation methodology. We conducted a meta-regression using the R package to meta-explore whether age, sex, and invasive mechanical ventilation modified risk of infection with immune-based therapies. The protocol is registered with PROSPERO (CRD42021229406). Results This was a meta-analysis of 37 RCTs including 32 621 participants (mean age, 60 years; 64% male). The use of immune-based therapy for COVID-19 conferred mild protection for the occurrence of secondary infections (711/15 721, 4.5%, vs 616/16 900, 3.6%; RR, 0.82; 95% CI, 0.71–0.95; P = .008; I2 = 28%). A subgroup analysis did not identify any subgroup effect by type of immune-based therapies (P = .85). A meta-regression revealed no impact of age, sex, or mechanical ventilation on the effect of immune-based therapies on risk of infection. Conclusions We identified moderate-certainty evidence that the use of immune-based therapies in COVID-19 requiring hospitalization does not increase the risk of secondary infections.

Background Cancer and pulmonary tuberculosis are major global health concerns and are associated with substantial morbidity and mortality. The association between active tuberculosis and subsequent cancer development has been investigated for many years. This study was planned to determine the prevalence of latent tuberculosis infection in patients with recently diagnosed bronchogenic carcinoma. Methods Sixty-four newly diagnosed primary lung cancer patients were enrolled. Diagnosis of latent tuberculosis infection was performed with QuantiFERON-TB Gold In-Tube tests, with exclusion of active tuberculosis. Results Latent tuberculosis infection was detected in 16 (25%) patients, and 8 (12.5%) had indeterminate results of the QuantiFERON-TB Gold In-Tube test. Being a current smoker was associated with a higher prevalence of latent tuberculosis ( p = 0.001). Comorbidities, tumor site, and histopathology were not associated with latent tuberculosis infection. Conclusions There is a considerable risk of concurrent latent tuberculosis in newly diagnosed primary bronchogenic carcinoma. The need for treatment of latent tuberculosis in these patients and its influence on the outcome and prognosis are issues for further investigations.

Introduction: Undescended testis is a relatively common congenital anomaly in male children with a prevalence of 1%–2% in live births. Upon discovering an empty scrotum, it is important to determin...

Background The care of terminally ill patients is fraught with ethical and medical dilemmas carried by healthcare professionals. The present study aims to explore the approaches of Lebanese attending physicians towards palliative care, end of life (EOL) care, and patient management in two tertiary care university hospitals with distinct medical culture. Methods Four hundred attending physicians from the American University of Beirut Medical Center (AUBMC) and Hotel Dieu de France (HDF) were recruited. Participants were Medical Doctors in direct contact with adult patients that could be subject to EOL situations providing relevant demographic, educational, religious as well as personal, medical or patient-centric data. Results The majority of physicians in both establishments were previously exposed to life-limiting decisions but remains uncomfortable with the decision to stop or limit resuscitation. However, physicians with an American training (AUBMC) were significantly more likely to exhibit readiness to initiate and discuss DNR with patients (ppp=0.003). The majority of respondents reported that previous directives from the patient were fundamental to life-limiting decisions. However, the influence of patient and medical factors (e.g. culture, religion, life expectancy, age, socioeconomic status) was evidenced in the HDF group. Conclusion Early physician-initiated EOL discussions remain challenged in Lebanon. Paternalistic attitudes limit shared decision making and are most evident in European-trained physicians. Establishing a sound and effective framework providing legal, ethical and religious guidance is thus needed in Lebanon.

We systematically evaluated the impact of positive surgical margins (PSM) on oncological outcomes after partial nephrectomy for renal cell carcinoma. Forty-two studies comprising 101,153 subjects were included and five distinct meta-analyses were performed. PSM was associated with increased risk of local recurrence (hazard ratio (HR) 6.11—high certainty), metastasis (HR 3.29—moderate certainty), overall relapse (HR 2.25—high certainty), overall mortality (HR 1.30—moderate certainty), and may be associated with increased cancer-specific mortality (HR 1.91—low certainty). Patients with PSM should be counseled for the possibility of additional surgery, novel adjuvant therapies, and more rigorous surveillance.

Rania Abd El-Hamid El-Kady,1,2 Dania Waggas,2 Ahmed AkL3,4 1Department of Medical Microbiology and Immunology, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 2Department of Pathological Sciences, Fakeeh College for Medical Sciences, Jeddah, Kingdom of Saudi Arabia; 3Department of Nephrology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt; 4Department of Internal Medicine/Adult Nephrology, Dr. Soliman Fakeeh Hospital, Jeddah, Kingdom of Saudi ArabiaCorrespondence: Rania Abd El-Hamid El-KadyDepartment of Pathological Sciences, Fakeeh College for Medical Sciences, Jeddah, 2537, Kingdom of Saudi ArabiaTel +966 569849897Email raniael_kady@yahoo.comBackground: Albeit growing technical advances in the design of hemodialysis catheters, intravascular catheter-related bloodstream infection (CRBSI) still represents an utmost clinical challenge to the health-care workers (HCWs). Data regarding the influence of the culprit organism on the scenario of CRBSI in the literature are extremely lacking. Thereby, this research was carried out.Methods: We undertook a retrospective cohort study over an interval of 2 years, involving patients who underwent regular hemodialysis via catheters in the Renal Dialysis Unit (RDU) of Dr. Soliman Fakeeh Hospital (DSFH), Jeddah, Kingdom of Saudi Arabia (KSA). The study enrolled 139 patients (56.8% females and 43.2% males), with mean age of 60.79 ± 11.45 years.Results: The aggregate rate of CRBSI was 5.1/1000 catheter days. Amongst the 139 study candidates confirmed of having CRBSI, while 69.8% of CRBSIs were ascribed to Gram-positive cocci, about one-third of the infectious episodes were secondary to Gram-negative bacilli. Interestingly, fever was the most common presentation of S. aureus CRBSI compared to CoNS and Gram-negative bacilli CRBSIs (20.9% versus 12.9% versus 6.5%, p= 0.0001), whereas CRBSIs due to CoNS were presented mainly with rigors (19.4%). Of note, CRBSIs caused by Gram-negative bacilli had a tendency to manifest with unusual symptoms such as vomiting or hypotension. Besides, they were more prone to involve hospitalization or ICU admission. In this study, no mortality was attributed to CRBSIs.Conclusion: Our study disclosed that the illicit organism has a repercussion on the clinical presentation as well as the fate of CRBSI among hemodialysis patients. This highlights the worth of identifying the infected cases in a periodic manner, to avoid the occurrence of devastating complications. A large body of work from various hemodialysis centers should take place in the near future so as to provide more insight in this perspective.Keywords: hemodialysis, catheter, ESRD, CRBSI, susceptibility

BACKGROUND: Homozygous familial hypercholesterolemia is characterized by premature cardiovascular disease caused by markedly elevated levels of low-density lipoprotein (LDL) cholesterol. This disorder is associated with genetic variants that result in virtually absent (null-null) or impaired (non-null) LDL-receptor activity. Loss-of-function variants in the gene encoding angiopoietin-like 3 (ANGPTL3) are associated with hypolipidemia and protection against atherosclerotic cardiovascular disease. Evinacumab, a monoclonal antibody against ANGPTL3, has shown potential benefit in patients with homozygous familial hypercholesterolemia. METHODS: In this double-blind, placebo-controlled, phase 3 trial, we randomly assigned in a 2:1 ratio 65 patients with homozygous familial hypercholesterolemia who were receiving stable lipid-lowering therapy to receive an intravenous infusion of evinacumab (at a dose of 15 mg per kilogram of body weight) every 4 weeks or placebo. The primary outcome was the percent change from baseline in the LDL cholesterol level at week 24. RESULTS: The mean baseline LDL cholesterol level in the two groups was 255.1 mg per deciliter, despite the receipt of maximum doses of background lipid-lowering therapy. At week 24, patients in the evinacumab group had a relative reduction from baseline in the LDL cholesterol level of 47.1%, as compared with an increase of 1.9% in the placebo group, for a between-group least-squares mean difference of -49.0 percentage points (95% confidence interval [CI], -65.0 to -33.1; P

Background: Visual field defects (VFD) usually do not show improvement beyond 12 weeks from their onset. It has been shown that repetitive presentation of a stimulus to areas of residual vision in cases of visual field defect can improve vision. The counterpart of these areas in the brain are the partially damaged brain regions at the perilesional areas where plasticity can be enhanced. Objective: We aimed to study the effect of navigated repetitive transcranial magnetic stimulation (rTMS) applied to perilesional areas on the recovery of patients with cortical VFD. Methods: Thirty-two patients with cortical VFD secondary to stroke of more than 3 months duration received 16 sessions of either active or sham high frequency navigated perilesional rTMS. Automated perimetry and visual functioning questionnaire (VFQ-25) were performed at baseline and after completion of the sessions. Results: The active group showed significant improvement after intervention, compared to the sham group, in both mean deviation (MD), visual field index (VFI) and in the VFQ-25 scores. Conclusions: Navigated rTMS is a new treatment option for post-stroke VFD as it can selectively stimulate areas of residual vision around the infarcted tissue, improving the threshold of visual stimulus detection which could be used alone or in combination with existing therapies.

Background and Objective This article explores the need for conceptual advances and practical guidance in the application of the GRADE approach within public health contexts. Methods We convened an expert workshop and conducted a scoping review to identify challenges experienced by GRADE users in public health contexts. We developed this concept article through thematic analysis and an iterative process of consultation and discussion conducted with members electronically and at three GRADE Working Group meetings. Results Five priority issues can pose challenges for public health guideline developers and systematic reviewers when applying GRADE: (1) incorporating the perspectives of diverse stakeholders; (2) selecting and prioritizing health and “nonhealth” outcomes; (3) interpreting outcomes and identifying a threshold for decision-making; (4) assessing certainty of evidence from diverse sources, including nonrandomized studies; and (5) addressing implications for decision makers, including concerns about conditional recommendations. We illustrate these challenges with examples from public health guidelines and systematic reviews, identifying gaps where conceptual advances may facilitate the consistent application or further development of the methodology and provide solutions. Conclusion The GRADE Public Health Group will respond to these challenges with solutions that are coherent with existing guidance and can be consistently implemented across public health decision-making contexts. post-print 456 KB

Introduction In December 2019, a new coronavirus has emerged out of China, the SARS-CoV-2 virus, causing a disease known as COVID-19, which steadily has progressed into a pandemic. This coronavirus affects many organs, including the skin, whose manifestations are a consequence of the disease itself, as well as the preventative measures taken to avoid the infection. This paper reviews the cutaneous manifestations which currently have been encountered during this pandemic. Methods A search was conducted on PubMed, and all relevant articles were included. Results The results show the occurrence of many cutaneous findings, ranging from those related to the infection itself and to various dermatitides related to the use of personal protective equipment (PPE) utilized by healthcare workers while attending to infected patients. Discussion Recognizing these findings is important for the accurate diagnosis of those infected with COVID-19 as well as the prompt treatment of the side effects caused by PPE that might further impair the effectiveness of healthcare workers.

Purpose: Immune checkpoint inhibitors (ICI) have shown clinical benefit in many types of metastatic cancers with only a few predictive biomarkers identified so far. CDKN2A is commonly altered in human cancers, but prior studies have provided conflicting evidence regarding the association between CDKN2A genomic alterations (GA) and response to ICIs. Herein, we examined the impact of loss-of-function CDKN2A alterations on response and survival in patients treated with ICIs. Experimental Design: We studied the association between loss-of-function CDKN2A alterations and the response to ICIs in two independent cohorts of six different cancer types. Seven hundred and eighty-nine patients treated at Dana-Farber Cancer Institute (DFCI; Boston, MA) and 1,250 patients treated at Memorial Sloan Kettering Cancer Center (MSKCC; New York, NY) were included in the final analysis. Patients' tumors were sequenced using Oncopanel or MSK-IMPACT. RNA sequencing data from The Cancer Genome Atlas and IMvigor210 were used to investigate differences in the tumor microenvironment. Results: In the DFCI cohort, CDKN2A GAs were associated with poor response and survival in patients with urothelial carcinoma treated with ICIs, but not those treated with platinum-based therapy. Similarly, CDKN2A GAs were associated with worse outcomes in the MSKCC urothelial carcinoma cohort treated with ICIs. There was no association of CDKN2A status with ICI treatment outcome in five other cancers: esophagogastric, head and neck, non–small cell lung, renal cell carcinoma, and melanoma. Immuno-inflammatory pathways were significantly reduced in expression in CDKN2A-altered tumors. Conclusions: Our data show that CDKN2A GAs were associated with reduced benefit from ICI therapy in urothelial carcinoma as well as changes in the tumor–immune microenvironment.

Study aim: To identify experiences and challenges among Pediatrics Intensive Care Units nurses during COVID 19 crisis. Study design: the descriptive qualitative design was used. Setting: This study carried out at all Pediatrics Intensive Care Units (PICU) in Port Said hospitals. Study subject: Snowball sampling of (115) Pediatric nursing staff worked In PICU in Port Said hospitals have participated in this study from the beginning of November 2020 to the beginning of February 2021.Data collection tools: a semi-structured electronic form applied to Pediatrics nursing staff in PICU. Two tools were used in the study, tool I: Assessment interview questionnaire sheet composed of two parts, socio-demographic data of pediatric ICU nursing staff & nurses’ experiences during the COVID 19 crisis. Tool II: Challenges faced pediatrics ICU nursing staff during COVID 19 crisis. Results: Most (87%) of pediatrics ICU nursing staff during the COVID 19 crisis faced a high challenges that high percentages (97.1%) of them faced moral challenges followed by social, psychological challenges, challenges related to the nature of the disease, challenges related to staff and resources deficiency then physical challenges (93.9%, 92.2%, 91.3%, 90.4%, 88.7%) respectively. The pediatrics nurses 'experiences indicated higher statistical significance regarding means of transportation, providing care for suspected and confirmed patients with p. value challenges that high percentages of them faced moral challenges followed by social, psychological challenges, challenges related to nature of the disease, challenges related to staff and resources deficiency then physical challenges. As well as, nurses 'experiences during COVID19 crisis was indicated higher statistically significant with total challenges regarding means of transportation, providing care for suspected and confirmed patient. Recommendations: Researches should be conducted to enhance knowledge on COVID-19 prevention and management& thus manipulation the challenges, experiences, and troubles faced by nursing staff during crises.

Although acute coronary syndromes (ACS) remain one of the leading causes of death, the clinical presentation has changed over the past three decades with a decline in the incidence of ST-segment elevation myocardial infarction (STEMI) and an increase in non-STEMI. This epidemiological shift is at least partially explained by changes in plaque biology as a result of the widespread use of statins. Historically, atherosclerotic plaque rupture of the fibrous cap was thought to be the main culprit in ACS. However, plaque erosion with an intact fibrous cap is now responsible for about one third of ACS and up to two thirds of non-STEMI. Two major research approaches have enabled a better understanding of plaque erosion. First, advanced intravascular imaging has provided opportunities for an 'optical biopsy' and extensive phenotyping of coronary plaques in living patients. Second, basic science experiments have shed light on the unique molecular characteristics of plaque erosion. At present, patients with ACS are still uniformly treated with coronary stents irrespective of the underlying pathobiology. However, pilot studies indicate that patients with plaque erosion might be treated conservatively without coronary stenting. In this Review, we discuss the patient phenotype and the molecular characteristics in atherosclerotic plaque erosion and provide our vision for a potential major shift in the management of patients with plaque erosion.

Background: Psoriatic arthritis is a chronic, immune-mediated, inflammatory arthropathy that presents with inflammation of the joints and entheses, including those of the axial skeleton, and is associated with increased mortality from cardiovascular disease. The aim of the work is to evaluate serum level of sclerostin in patients with psoriatic arthritis and to correlats its level with the severity and activity of psoriatic arthritis. Methods: This case control study included (50) subjects classified into two groups: Group I: 30 patients with psoriatic arthritis. Group II: 20 healthy age and sex matched individuals as a control group. Results: there were no statistically significant differences between case group and control group, with a mean value of 42.45±12.90 vs 41.05±9.84 respectively. Regarding sclerostin , it found that there were no statistically significant differences between case group and control group with a mean value of 2787.92±1838.06 vs 2235.53±1830.67 respectively, And it found that there were highly statistically significant differences between groups with high mean value in patients with psoriasis group of 4276.72±1239.7 when it compared with other groups. Conclusion: The significantly higher serum sclerostin levels in PsA patients, compared with controls; there was positive significant correlation between sclerostin and each of age and PASI score. Sclerostin plays an important role in the pathogenesis of PsA and its associated bone damage, either systemic or localized.

Background Breast cancer is a common disease in Tunisia and is associated with high mortality rates. The “Instance Nationale de l’Evaluation et de l’Accréditation en Santé” (INEAS) and the Tunisian Society of Oncology decided to develop practice guidelines on the subject. While the development of de novo guidelines on breast cancer screening is a demanding process, guideline adaptation appears more appropriate and context sensitive. The objective of this paper is to describe the adaptation process of the European Guidelines on Breast Cancer Screening and Diagnosis to the Tunisian setting in terms of the methodological process, contextual differences between the source and adoloped guideline, and changes in the recommendations. Methods We used the ‘Grading of Recommendations Assessment, Development and Evaluation’ (GRADE)-ADOLOPMENT methodology to prioritize the topic, select the source guideline, and prioritize the questions and the outcomes. Once the source guideline was selected—the European Breast Cancer Guidelines—the European Commission´s Joint Research Centre shared with the project team in Tunisia all relevant documents and files. In parallel, the project team searched for local studies on the disease prevalence, associated outcomes’ baseline risks, patients’ values and preferences, cost, cost-effectiveness, acceptability, and feasibility. Then, the adoloping panel reviewed the GRADE evidence tables and the Evidence to Decision tables and discussed whether their own judgments were consistent with those from the source guideline or not. They based their judgments on the evidence on health effects, the contextual evidence, and their own experiences. Results The most relevant contextual differences between the source and adoloped guidelines were related to the perspective, scope, prioritized questions, rating of outcome importance, baseline risks, and indirectness of the evidence. The ADOLOPMENT process resulted in keeping 5 out of 6 recommendations unmodified. One recommendation addressing “screening versus no screening with ultrasound in women with high breast density on mammography screening” was modified from ‘conditional against’ to ‘conditional for either’ due to more favorable ratings by the adoloping panel in terms of equity and feasibility. Conclusion This process illustrates both the feasibility of GRADE-ADOLOPMENT approach and the importance of consideration of contextual evidence. It also highlights the value of collaboration with the organization that developed the source guideline.

Background Pericardial patches are often used for repair of congenital cardiac defects. The aim of this study was to describe our initial experience with the use of equine pericardium and its safety and advantages and disadvantages compared to bovine pericardium. Methods We designed a retrospective cohort study of 111 patients who were surgically treated for congenital heart disease between 2017 and 2020. Equine pericardium was used in 58 patients and bovine pericardium was used in 53 patients. Recorded variables included demographic data, preoperative cardiac pathology, site of patch insertion, morbidity and mortality. Results The overall survival rate was 94.5% and no deaths were related to patch insertion. None of our patients were reoperated on for patch related complications. Postoperative transcatheter intervention was needed in 2 patients (1.8%): one for dilatation of aortic arch stenosis after repair of hypoplastic left heart syndrome with equine pericardium and one for dilatation of pulmonary artery branches after repair of tetralogy of Fallot using bovine pericardium. Conclusions Equine pericardium is a safe patch material for reconstruction in congenital heart surgery. It may be preferable to bovine pericardium in cases requiring a complex shape or a pliable patch as in in arch reconstruction or for valve reconstruction.

Psoriasis is resistant interceded persistent and repetitive, fiery dermatosis skin infection. netrin 1 has a significant part in the pathogenesis of a few immune system sicknesses. This examination is intended to assess the conceivable job of Netrin 1 in the pathogenesis of psoriasis by estimating its level in the serum of psoriatic patients and associate its level with the seriousness. which may help later on treatment of psoriatic injury. This examination included 60 patients experiencing psoriasis vulgaris . Furthermore, 30 obviously solid people of coordinated with age and sex will be picked as a benchmark group. All patients will be exposed to finish history, complete general and dermatological clinical assessment will be finished. Assessment of serum level of netrins 1 in patients and control bunches by ELISA. By contrasting the two gatherings of patients and controls in this investigation there was a huge reduction in the mean serum level of Netrin1 in psoriatic patients contrasted and controls. There was high critical positive connection between's PASI score (seriousness of disease)and level of infection ,while there was no huge relationship between's PASI score and illness span or age. There was high huge negative connection between's Netrin1 level and degree likewise there was critical negative relationship between's Netrin1and Disease span while there was no huge relationship between's Netrin 1 and age and sex. There is a part of Nerrin1 in the pathogenesis of psoriasis.Netrin1 can be utilized as marker of sickness degree and illness length.

Background Our primary and secondary aims were to analyze the evidence surrounding mortality and re-bleeding risks in patients on aspirin with non-variceal upper gastrointestinal bleeding (NVUGIB) as a function of whether or not aspirin was resumed after the bleeding episode, and to determine whether aspirin intake upon admission affected the outcomes. Methods A search for randomized controlled trials (RCTs) and prospective observational studies was performed. Data extraction and risk of bias assessment were done. Generic inverse variance and random-effects model were employed. Heterogeneity across studies was assessed using the I 2 test. Certainty of evidence was assessed using the GRADE approach for each comparison and outcome, and an evidence profile was created. Results Evidence from 1 RCT and 4 observational studies suggests that early aspirin resumption reduced mortality (hazard ratio [HR] 0.20, 95% confidence interval [CI] 0.06-0.63) while increasing re-bleeding risk (HR 1.90, 95%CI 0.60-6.00); moderate certainty of evidence. The observational evidence was inconsistent for both mortality (HR 0.84, 95%CI 0.54-1.33) and re-bleeding (HR 0.85, 95%CI 0.47-1.55); very low certainty of evidence. Nine observational studies addressed our secondary aim: 6 provided inconsistent results regarding mortality (pooled odds ratio [OR] 1.1, 95%CI 0.80-1.50) and 4 provided inconsistent results regarding re-bleeding risk (pooled OR 0.92, 95%CI 0.53-1.59); very low certainty of evidence for both outcomes. Conclusion Evidence supporting a protective effect of aspirin resumption soon after NVUGIB is of low-to-moderate certainty, and is not informative as to the optimal timing of aspirin resumption.

Background: Simulation is the imitation of a real-world process over time. Theoretical education is not adequate alone for effective cardiopulmonary resuscitation applying. So that the application must be given in accordance with training and manual guidelines. Aim: to evaluate effectiveness of a simulation based learning on nursing intern-ship students' performance and self-efficacy regarding pediatrics basic life support. Design: quasi-experimental research design was used. Setting: study conducted at Aswan University Hospital Training Center. Study subject: Convenient sample of 100 nursing internship students of Nursing Faculty, Aswan University at academic year 2019-2020 from October 2019 to March2020.Data collection tools were included two basic tools, the first tool was Nursing Internship student’s Performance regarding pediatric basic life support that included socio-demographic characteristics, students ' knowledge, ' practice, and the second tool was self-efficacy assessment. Results revealed marked increase in nurses' total knowledge, practice and self-efficacy after implementation of emergency pediatric basic life support compared to pretest with statistically significant differences. Conclusions: simulation improved nursing student' performance and self-efficacy regarding pediatric basic life support and enhance the simulation integration as active learning methods to improve nursing students ' performance. Recommendations: Repeating stimulation based learning training throughout nursing education to increase stimulation practices effectiveness.

BackgroundCOVID-19–related acute illness is associated with an increased risk of venous thromboembolism (VTE).ObjectiveThese evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in decisions about the use of anticoagulation for thromboprophylaxis in patients with COVID-19 who do not have confirmed or suspected VTE.MethodsASH formed a multidisciplinary guideline panel, including 3 patient representatives, and applied strategies to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including performing systematic evidence reviews (up to March 2021). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the grading of recommendations assessment, development, and evaluation (GRADE) approach to assess evidence and make recommendations, which were subject to public comment.ResultsThe panel agreed on 1 additional recommendation. The panel issued a conditional recommendation against the use of outpatient anticoagulant prophylaxis in patients with COVID-19 who are discharged from the hospital and who do not have suspected or confirmed VTE or another indication for anticoagulation.ConclusionsThis recommendation was based on very low certainty in the evidence, underscoring the need for high-quality randomized controlled trials assessing the role of postdischarge thromboprophylaxis. Other key research priorities include better evidence on assessing risk of thrombosis and bleeding outcomes in patients with COVID-19 after hospital discharge.

Background: COVID-19–related critical illness is associated with an increased risk of venous thromboembolism (VTE). Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in making decisions about the use of anticoagulation for thromboprophylaxis in patients with COVID-19–related critical illness who do not have confirmed or suspected VTE. Methods: ASH formed a multidisciplinary guideline panel that included 3 patient representatives and applied strategies to minimize potential bias from conflicts of interest. The McMaster University Grading of Recommendations Assessment, Development and Evaluation (GRADE) Centre supported the guideline development process by performing systematic evidence reviews (up to 5 March 2021). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the GRADE approach to assess evidence and make recommendations, which were subject to public comment. This is an update on guidelines published in February 2021. Results: The panel agreed on 1 additional recommendation. The panel issued a conditional recommendation in favor of prophylactic-intensity over intermediate-intensity anticoagulation in patients with COVID-19–related critical illness who do not have confirmed or suspected VTE. Conclusions: This recommendation was based on low certainty in the evidence, which underscores the need for additional high-quality, randomized, controlled trials comparing different intensities of anticoagulation in critically ill patients. Other key research priorities include better evidence regarding predictors of thrombosis and bleeding risk in critically ill patients with COVID-19 and the impact of nonanticoagulant therapies (eg, antiviral agents, corticosteroids) on thrombotic risk.

To evaluate serum level of Tenascin C in vasculogenic erectile brokenness patient and its relationship. Erectile brokenness (ED) is industrious failure to accomplish or keep up inflexible penile erection adequate for agreeable sexual execution. ED is viewed as of vascular beginning in by far most of the patients. Tenascin C protein (TN C) has an immediate job in vascular occlusive redesigning with deferred neointimal arrangement. Tenascin C can be considered as a potential biomarker in obsessive conditions portrayed by tissue injury and fibrosis. This examination included 80 Participants partitioned into two gatherings; bunch I included 50 patients determined by penile Doppler to have psoriasis and gathering II included 30 ( age and sex coordinated) evidently sound volunteers as a control. serum level of TN-C was estimated utilizing ELISA method in ED patients and contrasted with control bunch The consequences of our examination uncovered that patients had high measurably huge higher TN-C (p < 0.011) than control group.

Psoriasis is a common chronic inflammatory skin disease with a spectrum of clinical phenotypes and results from the interplay of genetic, environmental, and immunological factors. Micro albuminuria is considered to be maker of glomular disease and can be used to predict diabetic or hypertensive nephropathy. The aim of the study was to evaluate micro-albuminuria and renal artery resistance index in psoriatic patients as an early diagnostic marker of kidney affection. Methods: This was a cross sectional casecontrol study, included 84 subjects classified into two groups: Patient group: 50 patients complaining of psoriasis. Control group: 34 apparently healthy of matched age and sex as control grouP.Each patient was subjected to full history taking, and complete clinical examination, Clinical assessment of psoriatic lesions is done to to determine the distribution, clinical variants and the extent of psoriasis. Assessment of psoriasis grade was done using PASI score. All studied subjects were tested for: Measuring microalbumuria in urine by ELISA. Results and conclusion: On comparing both groups of patients and controls in this study there was a significant increase of the mean level of microalbuminuria in psoriatic patients compared with controls. There was a positive correlation between the level of microalbuminuria and severity of psoriasis (PASI score) with a significant value. Microalbuminuria and renal artery resistance were elevated in psoriatic patients and has positive correlation with disease severity and may have a role in disease pathophysiology.

Vitiligo is a secured pigmentary disarray of the skin and mucous layers that is portrayed clinically by the improvement of particularly included white macules and patches of skin and hair ,Neurokinin An is accessible in excitatory neurons and secretory cells of the hypothalamic–pituitary–adrenal center .Additionally, both SubstanceP are neurokinin An is found in the neurosensory structure and change a wide extent of red hot and tissue fixing measures. The purpose of the work is to evaluate Neurokinin A serum level in vitiligo patients and its relationship with individual fulfillment. fifty subjects encountering non segmental vitiligo and avowed by wood's light and thirty clearly solid subjects , sex and age composed individuals who filled in as a control in the Banha school clinical center, they were attempted serologically for level of neurokinin A level with examination of individual fulfillment by dermatology life quality record questionair. The mean age with patients was 30±10.8 years old, while in control it was 27 ±7 years old. There was no immense differentiation between the two social occasions as regard age (P=0.06.(The understanding get-together included 18 (36%) male and 32 (64%) female, while controls included 14(46.7%)male and 16 (53.3%) females. There was no enormous differentiation between the two social occasions as regard sex ( p regard = 0.35).The results of our assessment revealed that patients had high quantifiably basic higher NKA (p < 0.001)with mean±SD (500.91±119.3) than control bundle with mean ±SD (109.55±80.51) .vitiligo has genuine impact on close to home fulfillment especially on more young age pack with mean age of the generally affected patients 23.8 years old . NKA is high in vitilligo patients differentiated and controls. There was positive relationship among's reality and dermatology life quality rundown with verifiably enormous worth

This study depicts the case of a young female presenting with intestinal obstruction. Surgery uncovered a small bowel hamartoma that has caused a transmesenteric internal hernia and volvulus. As far as we know, this is unheard of before, as all three mentioned entities are very rare. The study also covers a literature review of cases of internal hernia with volvulus and stresses over the need for urgent diagnosis and management.

Background: The valve disease is frequently caused by the rheumatic mitral stenosis in developing and developed countries alike and it is still a key issue. Although there is a significant decrease in rheumatic fever diffusion, its percentage is still about 12% of the native valvular heart disease. Aim of Work: The key objective of this work was to assess the impact of percutaneous mitral balloon valvuloplasty (PMBV) on the LV torsion and this objective was achieved by using the two-dimensional speckle-tracking echocardiography. Patients and Methods: The study used the prospective observational method and had been carried out in the Department of Cardiology, Al-Azhar University Hospitals. The treatment group consisted of 35 patients who were candidates for PMBV and the control group consisted of 20 matching patients in terms of gender and age but they were healthy. All the participants of study had been assessed using the conventional echocardiography and speckletracking echocardiography on the previous day and 3 months after the procedure. Results: Using the parameters of the conventional echocardiography, we found that there were no significant differences between the treatment group and the control group in the LV ejection fraction (EF) and RV systolic function (TAPSE) before the PMBV. After applying the Speckle-tracking echocardiography, the results indicated that LV torsion decreased in the treatment group compared to the control group before the PMBV. After 24 hours and 3 months after the PMBV, the patients of treatment group had shown a statistically significant improvement in LV torsion. Conclusion: The LV torsion in MS patients significantly improved immediately and in the short-run follow-up after the PMBV

Objectives The aim of this study was to assess the efficacy of laparoscopic transperitoneal pudendal decompression in the improvement of refractory lower urinary tract symptoms (LUTS) in young males presenting with clinical features of pudendal nerve entrapment with no known comorbidities that could explain their LUTS. Methods This is a prospective pilot study involving patients suffering from LUTS refractory to standard treatment and clinical features of pudendal nerve entrapment on physical examination. They underwent laparoscopic transperitoneal pudendal decompression. International Prostate Symptom Score (IPSS) and maximal flow (Qmax) on uroflowmetry were evaluated before and 3 months after the procedure. Results Five male patients aged 34 ± 4 years were recruited. The median IPSS differed significantly before and 3 months after the procedure (18 vs 8, P = .042); likewise, median Qmax differed significantly before and 3 months after the procedure (12 vs 18 mL/s, P = .042). Conclusion Pudendal nerve entrapment syndrome should be considered as a main differential diagnosis for refractory LUTS in young males with no other comorbidities. When clinical features of pudendal nerve entrapment are present, laparoscopic transperitoneal pudendal decompression relieves LUTS in these young males.

Objective: Surgical resection of hilar cholangiocarcinoma carries significant morbidity and mortality, particularly if postoperative bile leak occurs. Prognostic factors and scoring tools have been described for overall morbidity and mortality but none are specific for postoperative bile leak. In this study, we investigate the prognostic utility of various factors in predicting overall morbidity, mortality and risk of biliary leak in Bismuth Type III tumors with the hopes of developing a scoring tool in future research. Materials and Methods: A retrospective sample of 23 patients with Bismuth Type III tumors exclusively who underwent surgery between 2010 and 2017 were selected for this study. Demographic, surgical, pathologic and biochemical data were collected from the patients’ medical records. Results: 11 patients underwent a right hepatectomy for type IIIa tumors and 10 patients underwent a left hepatectomy for type IIIb tumors. 2 patients were lost to follow up and were excluded. R0 resection was achieved in 20 patients. Overall survival at 1, 3 and 5 years was 78.3%, 61.9% and 38.1%, respectively. A BMI >24kg/m2 was associated with a worse prognosis, increased overall morbidity and decreased survival at 1, 3 and 5 years (p0.74 was associated with decreased 5-year survival (p24kg/m2 and a preoperative creatinine >0.74 are associated with a poor prognosis in Bismuth Type III Klatskin tumors. Furthermore, Age, sex, preoperative hemoglobin, tumor size, use of CUSA and type IIIb tumors demonstrate a borderline significant association with the occurrence of postoperative bile leak.

Objective: The aim of this work was to evaluate Multidetector Computed Tomography (MDCT) findings of hepatic manifestation in common malignant hematological disorders. Materials and Methods: This retrospective study included 300 patients with different types of malignant hematological disorders. They were 119 female and 181 male (mean age, 45.4 year; range, 5-70 years). The most common hematological disorder was Non-Hodgkin lymphoma (NHL) detected in 192/300 (64%) patients and then Hodgkin disease (HD) detected in 40/300 (13.3%) patients. All 300 patients had ultrasonography. Clinical evaluation and laboratory assessment were done for all patients. Whole body and triphasic abdominal CT scanning was performed on 64 MDCT systems. Results: MDCT scanning revealed hepatic affection in 82/192 of NHL. All these 82 cases revealed hepatomegaly and focal lesion detected in 36 cases. As regard Hodgkin disease (HD), hepatomegaly detected in 22/40 cases and focal lesion detected in 8/40 cases. Hepatomegaly detected in 8/14 cases of acute myeloid leukemia (AML) and focal lesion detected in 4/14 cases. In cases of chronic lymphocytic leukemia (CLL), hepatomegaly detected in 6/22 cases with no detection of focal lesion. Conclusion: Hepatic involvement is often observed in several malignant hematological disorders, resulting in abnormalities in liver imaging studies. Malignant hematological disorders must be considered in hepatomegaly and hepatic focal lesions either single or multiple. MDCT is the diagnostic modality of choice for diagnosis and follow up of liver affection in different malignant hematological disorders.

Introduction Armed conflict may influence the size and scope of research in Arab countries. We aimed to assess the impact of the 2011 Syrian conflict on health articles about Syria published in indexed journals. Methods We conducted a scoping review on Syrian health-related articles using seven electronic databases. We included clinical, biomedical, public health, or health system topics published between 1991 and 2017. We excluded animal studies and studies conducted on Syrian refugees. We used descriptive and social network analyses to assess the differences in rates, types, topics of articles, and authorship before and after 2011, the start of the Syrian conflict. Results Of 1138 articles, 826 (72.6%) were published after 2011. Articles published after 2011 were less likely to be primary research; had a greater proportion reporting on mental health (4.6% vs. 10.0%), accidents and injuries (2.3% vs. 18.8%), and conflict and health (1.7% vs. 7.8%) (all p p = 0.019). The proportion of research articles reporting no funding increased from 1.1 to 14.6% (p Conclusion To our knowledge, this is the first study to examine the impact of armed conflict on health scholarship in Syria. The Syrian conflict was associated with a change in the rates, types, and topics of the health-related articles, and authors’ affiliations. Our findings have implications for the prioritization of research funding, development of inclusive research collaborations, and promoting the ethics of conducting research in complex humanitarian settings.

Cancer initiation typically occurs when a proto-oncogene&rsquo, s coding region undergoes mutation, resulting in uncontrollable cell growth and division, or when a tumour suppressor gene&rsquo, s coding region is affected by a mutation that inhibits activity of the resulting gene product. The pathophysiologic result is, respectively, exaggerated cell-cycle growth or deficient programmed cell death. Osteopontin (opn) is an integrin-binding phosphoprotein that is expressed on the surface of normal cells. Osteopontin has a major role in diverse tumour components, especially those implicated in invasion and metastasis. In the present study, we aimed to illustrate the value of opn as a possible contributor in breast cancer (bca). This prospective study included 115 patients newly diagnosed with bca and distant metastasis who were recruited from the Oncology Center, Mansoura University, and the Department of Clinical Oncology and Nuclear Medicine, Mansoura University Hospital, Egypt. The patients recruited had been diagnosed with disseminated visceral metastasis (visceral crisis), with or without bone metastasis, patients with cranial metastasis were excluded from the study. All patients received first-line chemotherapy with docetaxel 75 mg/m2 plus cisplatin 75 mg/m2 or carboplatin 6 auc (area under the curve) on day 1 every 21 days for a maximum of 6 cycles or till development of toxicity. Trastuzumab (in cases of her2-positive disease) was given whenever possible (if government assistance or personal finances permitted). Serum levels of opn were assessed by enzyme-linked immunosorbent assay (elisa) before treatment was started. A group of 30 matched healthy women whose median serum opn level was 15 ng/dL were included, and that level was therefore defined as the cut-off value. In addition, opn gene mutation was determined by polymerase chain reaction (pcr). Correlations of pretreatment serum opn and opn gene mutation with various patient clinicopathologic variables, response to the treatment, progression-free survival (pfs), and overall survival (os) were assessed. Mean serum opn was highest in her2-amplified bca (64.4 &plusmn, 42.3 ng/dL), and then in triple-negative bca (55.9 &plusmn, 34.7 ng/dL), followed by the luminal B and A subtypes (38.4 &plusmn, 33.1 ng/dL and 36.3 &plusmn, 32.2 ng/dL respectively, p = 0.017). Testing by pcr revealed that opn gene mutation was highest in triple-negative bca (85% opn mutant vs. 15% non-mutant), and then in her2-overexpressed bca (80% opn mutant vs. 20% non-mutant), followed by luminal B bca (61.9% opn mutant vs. 38.1% non-mutant), the least expression was detected in luminal A bca (57.9% opn mutant vs. 42.1% non-mutant). Interestingly, patients with high serum opn and opn gene mutation experienced both poor pfs (median: 12 months vs. 14 months, p = 0.001) and poor os (median: 14 months vs. 18 months, p = 0.001). Moreover, participants with opn gene mutation experienced a poor response: of those with progressive disease, 74% had opn mutation and 26% had unmutated opn (p = 0.04). Additionally, high pretreatment serum opn was correlated with poor treatment response: 49.1 &plusmn, 33.8 ng/dL in patients with progressive disease and 35.5 &plusmn, 34.3 ng/dL in those who achieved a complete response, a partial response, or stable disease (p = 0.05). Strong concordance was found between high serum opn and opn gene mutation in 69 tumours (79.3%), and strong concordance was detected between normal or low serum opn and non-mutant opn in 28 tumours (60.8%). The current prospective work helps to highlight opn as a valid prognostic biomarker for patients with metastatic bca and reveals that high pretreatment serum opn and opn gene mutation are both strongly linked with poor response and survival. Concordance between elisa and pcr results indicates that either method can be used for the evaluation of opn. Increased opn gene mutation in triple-negative bca could assist in tailoring the treatment response in this very aggressive tumour subtype and could be considered a targetable molecule in future studies.

Background: St. Thomas (ST) and Del Nido (DN) cardioplegic solutions are widely used for myocardial protection during cardiac surgery. In 2016, our university hospital shifted from modified St. Thomas to Del Nido solution for both adult and pediatric cardiac surgery. This retrospective study was conducted to compare ST and DN solutions regarding surgical workflow and clinical outcome in pediatric and adult patients undergoing cardiac surgery. Methods: We reviewed 220 patients who underwent cardiac surgery requiring cardioplegic arrest. Patients were categorized in 2 groups: ST (n = 110) and DN (n = 110). Each group included 60 pediatric and 50 adult patients. Demographic, intraoperative, and postoperative variables were collected. Results: In pediatric patients, no significant difference was found between the 2 groups regarding clamping time, bypass time, need for defibrillation, inotropic score, postoperative ejection fraction (EF), period of mechanical ventilation, intensive care unit stay, or postoperative arrhythmias. One patient in the ST group required mechanical support by extracorporeal membrane oxygenation. We had 5 cases of pediatric mortality (3 in DN and 2 in ST, P = .64). In adult patients, significantly fewer patients in the DN group needed defibrillation than in the ST group. No significant difference was found regarding clamping time, inotropic score, or intraaortic balloon pump use. Mortality in adult patients was 6 cases (4 in ST group and 2 in DN group). Conclusion: DN cardioplegia solution is as safe as ST solution in pediatric and adult cardiac surgery. It has comparable results of myocardial protection and clinical outcome, with superiority regarding uninterrupted surgery and lower rate of defibrillation.

The potential testicular protective effect of nimesulide (NSE) was studied in cisplatin (CSP)-challenged rats. NSE therapy (10 mg/kg/day, p.o.) was applied for 15 days, and a single dose of CSP (7 mg/kg, i.p.) was administered on the 10th day. CSP significantly decreased the levels of serum testosterone, testicular reduced glutathione, and superoxide dismutase. CSP also significantly increased testicular malondialdehyde, nitric oxide, tumor necrosis factor-α, interleukin-1β, cyclooxygenase-2 (COX-2), prostaglandin E2, nuclear factor-κB p65, Bax, and caspase-3. NSE significantly ameliorated all the biochemical changes observed in CSP-challenged rats. Moreover, NSE significantly reduced the histopathological injury, and the expressions of phosphorylated c-Jun N-terminal kinase (p-JNK) and p38 mitogen-activated protein kinases (MAPKs) in testes of rats received CSP. It was concluded that NSE significantly blocked the CSP-induced acute testicular injury in rats through inhibition of MAPK/COX-2 signaling pathway, and by combating oxidative stress, inflammation, and apoptosis.

Industry through its funding of research and through its relationships with study authors can influence the results of research. Most journals have policies for reporting funding and disclosing conflict of interest (COI) to mitigate the influence of industry on research. The objective of this study is to assess the policies of surgery journals for the reporting of funding and the disclosure of COI. We described the prevalence and characteristics of funding and COI policies of journals indexed under "Surgery" in the Journal Citation Reports. We extracted data from publicly available information and through simulation of manuscript submission. Of the 186 eligible journals, 171 (92%) had policies for reporting of funding. None of the policies described procedures to deal with non-reporting or underreporting of funding. Of the 186 journals, 183 (99%) had a policy for disclosure of COI. All journals with a COI policy required disclosure of financial interest, while 96 (52%) required the disclosure of non-financial interests. Only 24 (13%) policies described how non-disclosure of COI affects the editorial process, and none described procedures to verify COI disclosure. Of the policies that required disclosing COI, 94 (51%) also required reporting the source of financial COI. Most journals have policies for reporting of funding and disclosure of financial COI. However, many do not have clear policies for disclosing non-financial COI. Major limitations in the policies include the lack of processes for the verification of disclosed interests and for dealing with underreporting of funding and of COI.

The current examination was an endeavor to evaluate the viability of IL bleomycin infusion for the treatment of verruca vulgaris. Just as to evaluate the results that were experienced during the investigation. This investigation was done on 30 patients grumbling of various verrucae vulgaris. Included 10 ordinary people, biopsy was taken from non sun uncovered skin (lower arm) and recolored by caspse3. 15 of them were biopsied before infusion of bleomycin intralesionally and inspected histologically and immuno-histochemiclly by H&E and caspase 3. similar 15 patients with another verrucae were biopsied after infusion of bleomycin intralesionally in third ,fourth and seventh day after infusion and analyzed by H&E and caspase3. the remainder of verrucae from all patients were infused bleomycin intralesionally like clockwork for 6 meetings most extreme and followed for complete leeway and repeat as long as 3 months. there was factually centrality in articulation and force of caspase 3 shows expanding in apoptosis after infusion, the articulation was cytoplasmic in dispersion and sketchy in design in all cases. intralesional bleomycin is a powerful and very much endured first line treatment in the treatment of verrucae vulgaris paying little mind to patient's age, sex, malady span or being treated before by any modalities.

OBJECTIVE. The objective of our study was to determine the accuracy of ultrasound (US) and CT in diagnosing appendicitis at our institution while taking into account the number of indeterminate examinations in accordance with the Standards for Reporting Diagnostic Accuracy (STARD) guidelines. MATERIALS AND METHODS. We retrospectively evaluated 790 patients who underwent US, CT, or both for evaluation of suspected appendicitis between May 1, 2013, and April 30, 2015. Patient characteristics and US and CT examination results were recorded. The reference standard was histopathology or 3 months of medical record follow-up if surgery was not performed; 3 × 2 tables were generated, and sensitivity, specificity, overall test yield, and accuracy were calculated according to STARD guidelines. For surgical cases, time to surgery (one-way ANOVA) was compared among patients who underwent US alone, CT alone, or both US and CT. RESULTS. A total of 473 of 562 US examinations had indeterminate findings (overall test yield, 15.8%); sensitivity and specificity in the 89 diagnostic examinations were 98.5% and 54.2%, respectively. Thirteen of 522 CT examinations were indeterminate (overall test yield, 97.5%); sensitivity and specificity in the remaining 509 CT examinations were 98.9% and 97.2%, respectively. Taking indeterminate studies into account, the accuracy was 13.7% for US and 95.6% for CT. The negative appendectomy rates were 17.7% (11/62) for US and 3.3% (9/276) for CT (p = 0.0002). Time to surgery was longer for patients who underwent US and CT (mean ± SD, 17.7 ± 8.9 hours) than US alone (12.9 ± 6.4 hours; p = 0.002) but was not longer for patients who underwent CT alone (16.3 ± 8.4 hours; p = 0.45). CONCLUSION. At our institution, a large proportion of US examinations are indeterminate for appendicitis. CT is the preferred first-line imaging test for evaluating appendicitis in nonobstetric adult patients.

Introduction: Patient centered outcome became of great interest nowadays. Patient’s pain and discomfort following free gingival graft procedure are common complain. Different palatal dressings are suggested to cover and protect the palatal donor site as stents, collagen gelatin scaffolds, platelet rich fibrin (PRF), hyaluronic acid (HA) and Alvogyl. However, in the literature no ideal agent has been emphasized. Objectives: This randomized controlled clinical trial compares for the first-time the effect of PRF versus HA palatal wound dressings on postoperative pain, post-surgical bleeding, and wound healing. Materials and methods: Following sample size calculation, 30 systemically healthy patients requiring palatal mucosal graft harvesting were randomized to receive either PRF or HA (intervention groups) or gelatin sponge (control group) as palatal dressings. Patient-reported visual analogue score (VAS) pain scores as primary outcome. Post-surgical bleeding and wound healing were considered as secondary outcomes. Results: VAS pain scores were reported minimal in PRF group throughout follow up intervals, PRF was statistically significant when compared to HA group at 3 and 7 days postoperative, PRF was statistically significant when compared to control group from 3 to 30 days postoperative and VAS in PRF was nearly 0 in day 14. PRF group showed the highest value of healing index during all the follow up intervals with mean 4.4 at 30 days that indicates a full healing of palatal wound area. Conclusions: Within this study’s limitations, PRF had better outcomes than both HA and gelatin sponge in means of cost, pain reduction, hemostasis and healing properties.

Androgenetic alopecia (AGA) which is also known as androgenic alopecia or male pattern baldness, is the most common type of progressive hair loss. Male androgenetic alopecia (MAA) is the most common form of hair loss in men, affecting 30-50% of men by age 50. Male androgenetic alopecia (MAA) occurs in a highly reproducible pattern, preferentially affecting the temples, vertex and mid frontal scalp.To estimate the Serum Amyloid A3 (SAA3) in young male patients with AGA and studying the relationship between the level of SAA3 and atherosclerosis. The investigation was done after endorsement by the Ethics advisory group on Research at Faculty of Medicine, Benha University. A composed educated assent was acquired from every member. This examination was a cross sectional case similar investigation. All patients chose from Outpatient Clinic of Dermatology, Venerology and Andrology Department of Benha University Hospitals. This examination was begun at January 2019 to June 2019.We found that the patients with grade III and IV androgenetic alopecia with family ancestry of heart illnesses and raised lipid profile levels had critical height of serum amyloid A3 than different gatherings. Male patients underneath age of 30 years with AGA exceptionally grade III, IV had raised SAA3 and have more dangers to create blood vessel atherosclerotic illness later on than the people without AGA at a similar age gathering.

Psoriasis is a chronic, immune-mediated, inflammatory disease of the skin. It is a multifactorial malady with hereditary foundation activated by enviromental factors and immunological middle people. Numerous Epidemiologic examinations proposed that patients with psoriasis are at expanded danger of cardiovascular disease.To assess serum salusin beta level in psoriatic patients. In this relative case-control study, 50 psoriatic patients (case gathering) and 30 age-and sexual orientation coordinated solid people filling in as a benchmark group, were chosen from the outpatients' facilities of the Dermatology, Venereology, and Andrology Department, Faculty of Medicine, Benha University, during the period from October, 2018 to May, 2019. This investigation found that the serum salusin-β levels were signifcantly higher in psoriasis patients contrasted with control group.This study found that the serum salusin-β levels were signifcantly higher in psoriasis patients contrasted with control gathering.

Introduction: The aim of this article is to describe our technique of bilateral laparoscopic pyelolithotomy (LP) in a 54-year-old patient with bilateral large stones of which one is a staghorn stone (SS). Case Presentation: The patient's legs were extended and spaced from each other; the table was tilted to the right and to the left in a way to use only five trocars for both sides. The calculi were delivered intact at the end of the procedure. Operating time was 208 minutes. Blood loss was 250 mL. Hospital stay was 3 days. Double-J stents were removed 4 weeks later. The patient was stone free with a stable serum creatinine. Conclusion: This case report is the first to describe a bilateral LP for large and SS. This procedure can minimize the postoperative morbidity and is associated with high stone-free rates. It is safe when done by expert surgeons, but further investigations are required to assess its reproducibility.

Aim: This study aimed to compare between the effect of pharmacoinvasive strategy (PI)& primary percutaneous coronary intervention (P-PCI) according to PCI related delay (door to ballon) on the mortality and morbidity during in-hospital stay and after 30-day follow up. Moreover, left ventricular systolic function was assessed by two-dimensional echocardiography at cardiology department, Tanta University. Patients and Methods: The study was conducted on 300 patients that were divided into 2 main groups. Group A consisted of patients had primary PCI as reperfusion therapy and further divided into three groups according to PCI related delay (door toballon). Group A1, PCI-related delay is ≤60 minute(92patients). Group A2, PCI-related delay is >60 to ≤ 90 minute. (54patients). Group A3, PCI-related delay is >90minute (78 patients). The second group (group B), include patients who under gopharmaco-invasive strategy, PCI within 24 hour after thrombolysis (76 patients). In the second group, coronary angiography was done immediately in cases of failed thrombolysis and for successful thrombolysis; coronary angiography was performed within 3 – 24 hours. Results: During hospital stay, more patients in group A3 died than those of group B or group A1, A2 with no statistical significance. In addition, morepatients in group A3 showed heart failure symptoms with statistical significance than those of group B, A1 and A2. Bleeding complications occurred significantly more in group B. During follow up visits more patients in group A3 complained of heart failure symptoms with statistical significance than those of group B, A1, A2 patients. Conclusion: Primary PCI without door to balloon time delay (≤90 minutes)was encouraged and had the best results on morbidity and mortality. Also, pharmacoinvasive strategy was encouraged as being better than primary PCI when door to balloon time showed marked delay(

There may be many predictors of venous thromboembolism (VTE) and bleeding in hospitalized medical patients, but until now, systematic reviews and assessments of the certainty of the evidence have not been published. We conducted a systematic review to identify prognostic factors for VTE and bleeding in hospitalized medical patients and searched Medline and EMBASE from inception through May 2018. We considered studies that identified potential prognostic factors for VTE and bleeding in hospitalized adult medical patients. Reviewers extracted data in duplicate and independently and assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. Of 69 410 citations, we included 17 studies in our analysis: 14 that reported on VTE, and 3 that reported on bleeding. For VTE, moderate-certainty evidence showed a probable association with older age; elevated C-reactive protein (CRP), D-dimer, and fibrinogen levels; tachycardia; thrombocytosis; leukocytosis; fever; leg edema; lower Barthel Index (BI) score; immobility; paresis; previous history of VTE; thrombophilia; malignancy; critical illness; and infections. For bleeding, moderate-certainty evidence showed a probable association with older age, sex, anemia, obesity, low hemoglobin, gastroduodenal ulcers, rehospitalization, critical illness, thrombocytopenia, blood dyscrasias, hepatic disease, renal failure, antithrombotic medication, and presence of a central venous catheter. Elevated CRP, a lower BI, a history of malignancy, and elevated heart rate are not included in most VTE risk assessment models. This study informs risk prediction in the management of hospitalized medical patients for VTE and bleeding; it also informs guidelines for VTE prevention and future research.

Objective The objective of the study was to systematically review the literature for proposed approaches and exercises conducted to prioritize topics or questions for systematic reviews and other types of evidence syntheses in any health-related area. Study Design and Setting A systematic review. We searched Medline and CINAHL databases in addition to Cochrane website and Google Scholar. Teams of two reviewers independently screened the studies and extracted data. Results We included 31 articles reporting on 29 studies: seven proposed approaches for prioritization and 25 conducted prioritization exercises (three studies did both). The included studies addressed the following fields: clinical (n = 19; 66%), public health (n = 10; 34%), and health policy and systems (n = 8; 28%), with six studies (21%) addressing more than one field. We categorized prioritization into 11 steps clustered in 3 phases (preprioritization, prioritization, and postprioritization). Twenty-eight studies (97%) involved or proposed involving stakeholders in the priority-setting process. These 28 studies referred to twelve stakeholder categories, most frequently to health care providers (n = 24; 86%) and researchers (n = 21; 75%). A common framework of 25 prioritization criteria was derived, clustered in 10 domains. Conclusion We identified literature that addresses different aspects of prioritizing topics or questions for evidence syntheses, including prioritization steps and criteria. The identified steps and criteria can serve as a menu of options to select from, as judged appropriate to the context.

Background Infantile myofibromatosis is a rare benign disease of mesenchymal origin. It occurs mostly in infants but can occur in children and adults. It presents in 2 forms: solitary and multicentric. The presence of an orbital component, whether as a solitary lesion or as part of the multicentric disease, is even rarer. Surgery is required when these tumors behave aggressively and grow rapidly or when they are large enough to cause compression symptoms. Several surgical approaches have been described to resect such lesions. Case Description We present a case of a solitary intraorbital myofibroma extending into the optic canal in a 6-year-old girl that was completely resected via an extended endonasal endoscopic approach. Conclusions This case report highlights the advantages of the extended endonasal endoscopic approach in terms of intraoperative and postoperative factors.