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Background: Metabolic dysfunction-associated steatotic liver (MASLD) disease is the commonest hepatic cause of liver fibrosis and cirrhosis after the introduction of the direct acting antivirals and eradication of hepatitis C. MASLD is usually associated with metabolic syndrome and elevated inflammatory markers. Magnetic resonance spectroscopy (MRS) offers a non-invasive diagnostic, alternative to liver biopsy. This is a case–control diagnostic-accuracy study conducted on 40 patients in the Hepato-gastroenterology Unit in the Internal Medicine Department, Ain Shams University Hospitals, to study the role of MRI spectroscopy as a new diagnostic model for assessment of liver steatosis in non-diabetic MASLD patients compared to the standard ultrasound and clinical criteria. MASLD was diagnosed by a combination of a validated ultrasound hepatic steatosis score grading system and hepatic steatosis index using clinical and laboratory parameters. MRS was performed in all patients and fat peak, water peak, and fat fraction % were measured, and diagnostic accuracy of different MRS is compared to the US scoring and different laboratory and clinical parameters. To our knowledge this is the first study conducted on MRS in our region and Egypt. Results: This study revealed no statistically significant difference between the two groups regarding HbA1C, creatinine, while there was highly statistically significant difference regarding fasting blood sugar, 2 h post-prandial glucose level, urine albumin, and low-density lipoprotein levels. Hepatic steatosis score grading by abdominal ultrasound on the 20 controls showed no fatty changes with grade 0 (50%), and on the 20 MASLD patients showed that 2 cases were grade 1 steatosis (5%), 9 cases were grade 2 steatosis (22.5%), and 9 cases were grade 3 steatosis (22.5%). The diagnostic accuracy of predicting hepatic steatosis using different MRS parameters: fat peak, water peak, and fat fraction had area under the curve of 99.9%, 88.6%, and 100%, respectively. The sensitivity and specificity of fat fraction in detecting hepatic steatosis were 100%. The sensitivity and specificity of the fat peak in detecting hepatic steatosis were 100% and 95%, respectively. Moreover, the sensitivity and specificity of the water peak in detecting the hepatic steatosis were 88.6% and 85%, respectively. There is a statistically significant correlation between the three MRS parameters and the abdominal ultrasound hepatic steatosis score grades. Conclusion: MRS parameters: fat fraction, fat peak, and water peak, have high diagnostic accuracy for predicting the liver steatosis. Moreover, MRS has the added advantage of being a non-invasive and a tool with low radiation risk. MRS also shows the metabolic changes in the liver and could be an eligible outcome in therapeutic clinical trials. [ABSTRACT FROM AUTHOR]

Background: Systemic Lupus Erythematosus (SLE) patients are more likely than the general population to suffer from thyroid illness. The major goal was to assess the thyroid dysfunctions due to immunological factors in Egyptian SLE children and how they are related to the course and severity of the illness. Methods: Fifty children and adolescents with SLE are included in this cross-sectional observational study. Every patient underwent a thorough physical examination and a comprehensive history taking. An enzyme-linked immunosorbent assay (ELISA) approach was used to evaluate the thyroid profile, anti-thyroglobulin (Anti-TG), and anti-thyroid peroxidase (anti-TPO) antibodies. Results: Of the 50 patients, the female: male ratio (F: M = 7:1) was 44 females and 6 males (12%). They were between the ages of 5 and 17. Out of the patients, thirty-two (64%) had thyroid dysfunctions, 19 (38%) had euthyroid sick syndrome, ten (20%) had overt hypothyroidism, three (6%) had subclinical hypothyroidism, and none had hyperthyroidism. Of the 50 patients, one (2%) had increased anti-TPO, whereas all other patients had normal anti-TG levels. A statistically significant negative correlation (p-value 0.007) was seen between the disease duration and free thyroxine (FT4). Furthermore, a significant negative correlation (p-values 0.015 and 0.028) was found when comparing the disease duration with thyroid antibodies (anti-TG and anti-TPO). Conclusion: In Juvenile Systemic Lupus Erythematosus (JSLE), thyroid dysfunctions can be identified. The disease duration but not its activity was significantly correlated with thyroid antibodies. For children with JSLE, thyroid function testing should be done on a regular basis. It is preferable to carry out additional thyroid antibody tests when necessary. [ABSTRACT FROM AUTHOR]

Background: Fluid overload is associated with increased morbidity and mortality in critically ill patients. An accurate assessment of fluid status in neonatal cardiac pediatric patients is required for assessment of fluid overload. Estimation of fluid status using different Doppler parameters may be helpful in determination of fluid status. Purpose: To evaluate difference in fluid status in neonates with and without congenital heart diseases. To detect sensitivity of Doppler Ultrasound in early determination of fluid status. To compare between different parameters (IVC diameter, IVCCI, and IVC/AO ratio) between cardiac and healthy neonates. Methods: Transabdominal Doppler parameters of 25 full-term newborns with congenital heart diseases and congestive heart failure were compared to 25 post-natal age and sex-matched normal healthy neonates serving as controls. Aortic as well as inspiratory and expiratory inferior vena cava diameters were measured. Subsequently, inferior vena cava collapsibility index (IVCCI) and inferior vena cava-to-aortic ratio (IVC/AO) were calculated. Results: Fluid overload detected by increased IVC diameter (decreased IVCCI and increased IVC/AO ratio) was observed in the cardiac compared to the control group. There was positive correlation between the fluid volume and the IVC diameter and IVC/AO ratio and negative correlation with the IVC collapsibility indices. Conclusions: Fluid overload with increased IVC diameter and lack of IVC collapsibility were observed in neonates with congenital heart diseases and congestive heart failure compared with those hemodynamically stable controls. We recommend the use of IVC diameter, IVCCI, and IVC/AO ratio as rapid, easy and sensitive parameters in assessing volume status. [ABSTRACT FROM AUTHOR]

Background: Hepatocellular carcinoma (HCC) complicated by portal vein thrombosis presents significant clinical challenges. This study aims to retrospectively assess the feasibility of stereotactic irradiation for treating bulky HCC, with or without vascular invasion. Method: In this retrospective analysis, the radiotherapy treatment plans and clinical follow-up data of 22 patients diagnosed with HCC, with or without portal vein thrombosis, were reviewed. These patients underwent stereotactic body radiation therapy (SBRT) between September 2019 and September 2022. Treatment involved administering 40-50 Gy in 5 fractions using SBRT with volumetric modulated arc therapy (VMAT)/4D-computed tomography. Descriptive statistics were utilized without the application of statistical tests. Results: The mean age of the patients was 65 years, with 77% being male. Portal vein thrombosis was present in 73% of the cases, and the average tumor size was 7.2 cm (range 5-12 cm). 59% of patients were classified as Child-Pugh B. The median follow-up duration was 8 months (range 3-36 months). At 3 months, tumor response assessments revealed that 59% of patients had a partial response and 41% had stable disease; by 6 months, 37% achieved complete response, 26% maintained a partial response, and 37% had stable condition. Failure patterns included intrahepatic failure in two patients (at 7 and 9 months) and extrahepatic loss in two others (at 6 and 10 months). Radiation-induced liver disease occurred in two patients at 9- and 11-weeks post-treatment, respectively. Liver cancer-specific mortality was 13.6%, while non-liver cancer-specific mortality stood at 9%. The progression-free survival rate was 82%. Conclusion: SBRT via VMAT represents a highly cost-effective, non-invasive local therapy with a favorable therapeutic ratio for treating bulky HCC cases, with or without vascular invasion. [ABSTRACT FROM AUTHOR]

Background: Sepsis is one of the main causes of death in newborns worldwide. Vitamin D levels during fetal and neonatal periods have a significant role in the development of the immunological system. The study aims to evaluate the association between vitamin D levels and the risk of early-onset neonatal sepsis in full-term neonates in a developing country. Methods: This case–control study was conducted at the Neonatal Intensive Care Units (NICUs) of Kasr Alainy Hospital, Cairo, Egypt. The study was composed of two groups; the sepsis group involved full-term neonates appropriate for gestational age with sepsis-related clinical signs. The control group included newborns with no signs of clinical/laboratory infection within 72 h of life. Blood samples were collected on admission during the first three days of life in both groups for the measurement of 25-hydroxyvitamin D levels, Complete Blood Count (CBC), C reactive protein (CRP), and blood culture. Results: Forty-five newborns with clinical and laboratory findings of early-onset neonatal sepsis within 72 h of life were enrolled, and the control group included forty-five newborns with no evidence of sepsis. Vitamin D levels in the sepsis group were significantly lower than in the control group. Apgar score at the first minute was significantly lower in the sepsis group. 57.8% of neonates with sepsis had positive blood cultures. There was a statistical difference between deficient, insufficient, and sufficient vitamin D levels regarding the duration of the NICU stay, which was longer in neonates with deficient vitamin D levels. CRP was significantly higher in neonates with deficient vitamin D levels. The area under the receiver operating characteristic curve for serum vitamin D in the prediction of neonatal sepsis was 0.76 at a cutoff < 19.7(ng/ml). Conclusion: In the current study, full-term newborns with EOS had considerably lower vitamin D levels than healthy controls. Through appropriate vitamin supplementation of the mothers during pregnancy, it could be possible to ensure adequate vitamin D levels for newborns. This may contribute to the reduction of the risk of EOS, together with the other well-known preventive measures (i.e. breastfeeding and intrapartum antibiotic prophylaxis). [ABSTRACT FROM AUTHOR]

Background: Hepatocellular carcinoma (HCC) is the first cause of cancer in Egypt. Recently, HCC developed post direct-acting antivirals (DAAs) differ in some characteristics from those developed without DAAs exposure regarding the biological features and behavior of HCC. We aimed to assess the epidemiological, clinical, laboratory, and radiological findings besides the biological behavior of HCC patients post DAAs in comparison to HCC not exposed to DAAs. An analytic cross-sectional research was performed at the National Liver Institute which is a tertiary multidisciplinary HCC center. Subjects included hepatitis C virus patients and were allocated into two groups: group I included 2036 HCC cases post-DAA treatment and group II included 6338 HCC cases who did not receive DAAs. Subjects were examined to evaluate clinical, laboratory, and radiological findings. Tumor staging was done using the BCLC staging system. Results: Group II showed a more advanced Child–Pugh score, FIB-4 index, and MELD score than Group I (P = 0.001). The multiplicity of hepatic focal lesions was elevated in group I than in group II (P = 0.033). AFP level was significantly elevated in group I than in group II (p = 0.012). Portal vein invasion was significantly elevated in group I than in group II patients (P = 0.001). Extrahepatic spread of HCC was significantly elevated in group I than in group II (P = 0.001). Infiltrative lesions were significantly elevated in group I than in group II (P = 0.002). Conclusion: Our study detected that the behavior in HCC post DAAs treatment is more aggressive in respect of the number of lesions, PV invasion; local and distant metastasis, and serum AFP level than in patients unexposed to DAAs. Strict surveillance in cirrhotic patients treated with DAA should be followed according to the international guidelines for early diagnosis and treatment of HCC. [ABSTRACT FROM AUTHOR]

Background: Neurogenic dysphagia is one of the most dangerous consequences of stroke leading to pulmonary infections and even death in stroke survivors. Aim: Evaluate the effect of implementing swallowing training exercises on neurogenic dysphagia among acute stroke patients. Design: A quasi-experimental research design. Setting: This study was conducted at Neurological Intensive Care Units of Tanta Main University Hospital which affiliated to Ministry of Higher Education and Scientific Research. Subjects: A purposive sampling of 60 patients with acute stroke aged from 21 to 60 years old, both sexes. Tools: Four tools were used in this study Tool I: Acute Stroke Patients' Assessment: It included three parts as the following: Part (1): Patients' demographic characteristics, Part (2): Patients' medical data, and Part (3): Patients' swallowing reflexes examination, Tool II: Functional Oral Intake Scale (FOIS), Tool (III): The 8-Point Penetration-Aspiration Scale (PAS), and Tool (IV): Dysphagia Observational Checklist. Results: The study finding revealed a highly statistically significant difference was observed among control & study group at 5th day of admission with (p= 0.000) post application of the swallowing training exercises regarding penetrationaspiration scale. Conclusions: Neurogenic dysphagia is a common problem notified among acute stroke patients that need special intervention to improve patients' status and decreased its complications. Recommendation: Manual log book about care of dysphagia and stroke patients should be available to nurses at Neurological Intensive Care Units as a teaching guide for patients with neurogenic dysphagia and Continues health education programs for patients and relatives to increase practices and knowledge on swallowing exercises. [ABSTRACT FROM AUTHOR]

Background: Deep vein thrombosis is a medical condition that can cause disability and a decreased quality of life. Aim: evaluate effect of educational program for nurses' performance and clinical outcome regarding occurrence of Deep Vein Thrombosis among major orthopedic surgery patients. Design Quasi-experimental design. Setting: conducted at Orthopedic Department of Educational International Hospital at Tanta University. Subjects: Purposive sample (50) nurses and (40) adult patients that were divided into two groups of 20 patients each of them. Tools: 4 tools were applied Tool I: Nurses Assessment structure questionnaire, Tool II: Observation checklist for nurses' practice, Tool III: Patients Assessment Sheet, Tool IV an evaluation sheet for DVT. Results there was significant progress in the nurses' attitude related to the prevention of deep vein thrombosis. and statistical improvement in clinical outcomes in study group rather than control group after implementing the educational program Conclusions: the results concluded that implementation of the nursing educational program resulted in improvement in Nurses' attitude and Patients' clinical outcomes Recommendations: Planning educational classes for orthopedic surgical patients about prevention of DVT following orthopedic surgery. [ABSTRACT FROM AUTHOR]

Background: Mucormycosis is an invasive and possibly fatal fungal infection that frequently affects the mouth. Co-infection in post COVID-19 patients is an emerging concern, owing to their complex nature and higher mortality. Therefore, this study aimed to report the underlying risk factors, clinical characteristics, presentation, and final outcome of COVID-19 associated oral mucormycosis cases. Results: This study included 51 patients with oral mucormycosis 28 (55%) males and 23 (45%) females. Twenty-three patients (45%) presented with deep necrotic ulcer, 16 patients (31%) presented with superficial ulcer, and 12 patients (23%) of them presented with fistula. The overall survival rate was 51% (26 patients recovered). On the other hand, mortality rate was 49% (25 patients), of which 68% suffered from uncontrolled diabetes mellitus. Conclusions: The mortality rate of COVID-19 associated mucormycosis cases with oral manifestations was found to be quite high mostly due to delayed diagnosis and lack of timely treatment. Thus, increasing the awareness of dentists and maxillofacial surgeons is crucial for the early diagnosis of oral mucormycosis which is vital to improve prognosis of this serious infection. This is of high importance in view of the escalating numbers of mucormycosis cases being recorded worldwide. [ABSTRACT FROM AUTHOR]

Background: Autoimmune hepatitis (AIH) is an organ specific autoimmune disease, which can manifest at any age of life. there is a high prevalence of extrahepatic autoimmune diseases in patients with AIH. Autoimmune thyroid diseases (ATDs) are the most frequent extrahepatic autoimmune disorders among patients with AIH. Aim of work is to detect the frequency of ATDs among Egyptian children with AIH. Methods: This research is a cross-sectional study conducted on 58 children with AIH aged ≤ 18 years. All patients were tested for free triiodothyronine (FT3), free tetraiodothyronine (FT4), thyroid stimulating hormone (TSH), anti-thyroid peroxidase (anti-TPO) and antithyroglobulin (anti-TG). Thyroid ultrasound (US) and thyroid scan were performed for patients with abnormal thyroid profile, borderline values, positive anti-TPO or anti-TG. Results: The mean ± standard deviation (SD) for the age of the patients was 11.3 ± 4.5 years. Out of 58 patients of AIH, 28 patients (48.3%) had associated other autoimmune diseases. Autoimmune thyroiditis was the most common associated autoimmune disease being present in 10 patients (17.2%). The thyroid status of AIT patients showed that 6 patients (60%) were euthyroid, 3 patients (30%) had subclinical hypothyroidism and only one patient (10%) was hyperthyroid. Conclusion: Autoimmune hepatitis in Egyptian children is commonly associated with other autoimmune diseases. Autoimmune thyroiditis is the most common to be associated with AIH in pediatric patients. As it is not usually clinically manifesting, regular screening for AIT in children with AIH is mandatory. [ABSTRACT FROM AUTHOR]

Introduction: Osteoporosis is common among postmenopausal women, and can affect their health and quality of life. However, it can be managed by physical activity. The present study aims to investigate the combined effect of core stability and dynamic resistive exercises on bone mineral density (BMD) in postmenopausal women. Material and methods: Sixty postmenopausal women diagnosed with osteoporosis, age 50 to 60, BMI < 30 kg/m², were randomly divided into two equal groups: the study group received core stability and dynamic resistance exercise (two sessions per week) in addition to 70 mg Alendronate (one tablet) per week for four months, while the control group only received 70 mg Alendronate (one tablet) per week (n = 30 each group). Both groups were assessed for BMD (dual-energy x-ray absorptiometry; DEXA), and quality of life (Oswestry Disability Index; ODI), both pre- and post-treatment. Results: Both groups demonstrated a significantly greater bone mineral density in the lumbar spine and left femoral neck and improved quality of life post-treatment compared to pre-treatment (p < 0.001). However, comparing groups, the study group demonstrated significantly higher lumbar spine (Z value = -5.588) and left femoral neck bone mineral density (Z value = -4.794), and significantly lower ODI score (F value = 243.686), compared to the control group (p < 0.001). Conclusions: Core stability and dynamic resistance exercise appear to be safe and effective methods in the treatment of osteoporosis in post-menopausal women. [ABSTRACT FROM AUTHOR]

Background: Human papillomavirus (HPV)-related multi phenotypic sinonasal carcinoma (HMSC) is a recently described tumor subtype with an unknown prognosis, often misdiagnosed with other sinonasal carcinomas, and associated with highrisk HPV (HR-HPV). The present study aimed to evaluate the expression of vascular endothelial growth factor (VEGF), Bcl-2-associated X protein (BAX), epidermal growth factor receptors (EGFR), ProEx™C, and human telomerase reverse transcriptase (hTERT) and assess their association with survival and clinicopathological characteristics. Methods: Between 2017 and 2022, 40 HMSC patients underwent surgical resection at the School of Medicine, Zagazig University Hospitals (Zagazig, Egypt). Tissue samples were examined for the presence of HR-HPV; absence of myeloblastosis (MYB), MYB proto-oncogene like 1 (MYBL1), and nuclear factor I/B (NFIB) fusions and the presence of myoepithelial proteins (calponin, S100, SMA), squamous differentiation markers (p63, p40, calponin), VEGF, BAX, ProEx™C, and hTERT by immunohistochemistry. All patients were followed up for about 54 months until death or the last known survival data. Data were analyzed using the Chi square test and Kaplan-Meier method. Results: The expression of VEGF, hTERT, and ProEx™C was significantly associated with age, advanced tumor stages, lymph node metastasis, tumor size, mortality, relapse, poor disease-free survival (DFS), and overall survival (OS) (P<0.001). BAX expression was significantly associated with tumor size, age, poor DFS, and relapse (P=0.01, P<0.001, P=0.035, and P=0.002, respectively). Conclusion: HMSC is strongly associated with HR-HPV. The expression of VEGF, EGFR, BAX, hTERT, and ProEx™C is associated with aggressive malignant behavior, poor survival, and poor prognosis, making them novel prognostic biomarkers for targeted therapeutics in HMSC. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of topical sialogogue spray containing 1% malic acid in the treatment of xerostomia in patients with type 2 diabetes mellitus. Material and Methods: A randomized double‐blind controlled clinical trial was conducted on 52 patients with type 2 diabetes mellitus suffering from xerostomia. Patients were assigned equally to test group who received a topical sialogogue spray containing 1% malic acid and control group who received a placebo spray. Both groups were instructed to use the spray on demand for 2 weeks. The Summated Xerostomia Inventory‐Dutch Version questionnaire (SXI‐D) and the unstimulated salivary flow rate were evaluated for all patients at baseline, 2 and 4 weeks after malic acid/placebo application. Results: At 2 week's follow‐up, the unstimulated salivary flow rate increased significantly from 0.059 ± 0.024 to 0.191 ± 0.064 and from 0.055 ± 0.026 to 0.078 ± 0.032 for test and control groups, respectively, with a statistically significant difference favoring the test group. SXI‐D scores showed a significant decrease from 10.73 ± 2.22 to 8.38 ± 2.28 in the test group (p < 0.05), while in the control group it decreased from 10.62 ± 1.75 to 10.23 ± 1.48 (p > 0.05). Conclusion: A sialogogue spray containing 1% malic acid increased the unstimulated salivary flow rate in patients with type 2 diabetes mellitus suffering from xerostomia. [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury (AKI) in patients with multisystem inflammatory syndrome (MIS), COVID-19 related infection has been increasingly recognized with a paucity of data on AKI incidence, related mortality, and the requirement of renal replacement therapy in children with MIS (MIS-C). Methods: This is a retrospective study evaluating the prevalence, severity, management and outcomes of AKI in a cohort of Egyptian children with MIS-children (MIS-C) post-COVID infection. Patients were included if they met the criteria for MIS-C based on CDC guidelines. All patients were evaluated for AKI diagnosis and staging according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Results: Between March 2021 and June 2023, a total of 655 confirmed COVID-19 cases were admitted and then followed up in our hospital, of whom 138 (21%) were diagnosed with MIS-C. Fifty-one patients developed AKI associated with MIS-C post-COVID infection, 42 of whom were included in the analysis. Thirty-one patients had AKI in a formerly healthy kidney, of whom 51% (16 patients) were classified as KDIGO stage 3, 5 patients needed hemodialysis and 13 needed mechanical ventilation. Higher WBCs count, and serum ferritin on admission were associated with more severe AKI (KDIGO stage 3) (p = 0.04), while multivariate analysis showed high serum ferritin to be independent predictor of more severe AKI (p = 0.02). Two patients (2/31) died during hospital admission, while no residual renal impairment was reported at the time of discharge of patients with previously normal kidney functions. Conclusion: More than one-third of patients with MIS-C develop AKI. Avoidance of nephrotoxic drugs, early recognition, and prompt management of AKI, including well-timed commencement of dialysis in MIS-C cases, is associated with favorable outcomes. [ABSTRACT FROM AUTHOR]

Objective The aim of the study is to investigate the relation of neonatal and maternal vitamin D and late-onset sepsis (LOS). Study Design One-hundred twenty term neonates along with their mothers were enrolled in this case–control study. Sixty neonates who were admitted in the neonatal intensive care unit by LOS and had not been previously admitted for last 48 hours and did not receive antibiotics or vitamin D were enrolled as cases (sepsis) group. On the other hand, 60 healthy term neonates were referred as control group. Maternal and neonatal serum 25-OH vitamin D levels were assessed in both the cohorts. Results Maternal and neonatal 25-OH vitamin D levels in cases (17.2 and 16.1 ng/mL, respectively) were significantly lower than in controls (22.7 and 21 ng/mL, respectively) p = 0.001. In the study group, the neonatal 25-OH vitamin D was negatively correlated with C-reactive protein and length of hospital stay (r = −0.616 and −0.596, respectively) p <0.001 for both. With a cut-off value of 12.9 ng/mL, the specificity and positive predictive value of neonatal vitamin D were 83.3 and 74.4%, respectively. The odds ratio was 1.088 (95% CI = 1.034–1.144)) for LOS in vitamin D-deficient neonates. Conclusion Neonates with higher vitamin D level are at lower risk of LOS than those with vitamin D deficiency. Maternal vitamin D correlates with neonatal vitamin D. These data suggest that maternal vitamin supplementation during pregnancy may lower the risk of LOS. Key Points Neonatal and maternal vitamin D deficiency increase risk of LOS. Neonatal vitamin D correlates with maternal vitamin D. Neonatal vitamin D is independent predictor for LOS. [ABSTRACT FROM AUTHOR]

Background: Breath-holding spells (BHS) are a benign common problem in young children. Autonomic nervous system dysregulation plays an important role in its pathogenesis. BHS may be associated with iron-deficiency anemia (IDA). Objectives: The objective of the study was to explore the clinicolaboratory profile of children with BHS, electrocardiography (ECG), and echocardiography (ECHO) findings. Methods: The study included 50 children with breath-holding spells (BHS) and 50 controls, enrolled over 16 months. Clinical evaluation involved detailed history-taking, physical examination, and growth assessment. Laboratory investigations included complete blood count, serum iron, and serum ferritin levels. Electrocardiography (ECG) recordings were analyzed for corrected QT interval (QTc) and QTc dispersion (QTcd). Echocardiography (ECHO) studies were conducted to exclude primary cardiac diseases. Ethical approval was obtained, and statistical analysis was performed using SPSS version 26."The study included 50 children with breath-holding spells (BHS) and 50 controls, enrolled over 16 months. Clinical evaluation involved detailed history-taking, physical examination, and growth assessment. Laboratory investigations, Electrocardiography (ECG) recordings and Echocardiography (ECHO) studies were conducted and were analyzed. Results: The mean age of our children was 35 ± 20 months with their ages ranging from 11 to 84 months. Thirty-one children were male (62%) and 19 were female (38%). Cyanotic spells were present in 35 (70%) children, 7 (14%) children were of the pallid type, and 8 (16%) children were of the mixed type. Detailed history, laboratory tests (complete blood count, serum iron, and serum ferritin), ECG, and ECHO were done. Anemia was found in 66% of them (44% had IDA). The corrected QT interval (QTc) was 0.45 ± 0.02 s, 16% of children had prolonged QTc (>0.46 s), and QTc dispersion (QTcd) was 0.03 ± 0.02 s. We found a highly significant difference (P = 0.001) between cases and controls as regards QTc values, and no significant difference (P = 0.32) between the two groups as regards QTcd values. Conclusions: The cyanotic type is more common than the pallid and mixed types of BHS. IDA is a common finding in BHS. QTc is increased in children with BHS, which is a sign of cardiac repolarization changes. Therefore, the use of ECG for the diagnosis of rhythm abnormalities in these children is reasonable. [ABSTRACT FROM AUTHOR]

Background: Lateral elbow pain is a prevalent musculoskeletal disorder affecting the elbow's epicondyle region. One form of lateral elbow pain is lateral epicondylitis, which is a degenerative disorder of the musculotendinous system. Adequate levels of vitamin D are essential for maintaining musculoskeletal health. Our study aimed to assess the role of vitamin D in lateral epicondylitis among Egyptians. Results: Our research revealed that there is a significant correlation between vitamin D deficiency and lateral epicondylitis. Patients with vitamin D deficiency displayed worse patient-rated tennis elbow evaluation score (PTREE), visual analog scale score (VAS), and grip strength. These findings indicate a statistically significant association between lateral epicondylitis patients with deficient vitamin D and each of the PTREE scores (p < 0.001), VAS score (p < 0.001), and hand grip strength (p < 0.001). Conclusion: The etiology of lateral epicondylitis is not yet fully understood. However, our study provides evidence supporting the notion that low levels of vitamin D may be one of the risk factors in the etiology of lateral epicondylitis among Egyptians. [ABSTRACT FROM AUTHOR]

Studies have shown that COVID-19 patients experience high levels of anxiety, depression, and stress during the pandemic. Patients adopt different coping strategies to reduce their psychological distress To compare the immediate and long-term psychological impact of COVID-19 disease on patients with and without chronic medical illnesses (CMI) and identify coping styles of both groups during the peak of COVID-19 disease in Egypt. This is a cohort follow-up study, that included an online survey consisting of General Health Questionnaire-12, Taylor Manifest Anxiety Scale, Beck Depression Inventory and Brief-COPE scale. The Post-Traumatic Stress Disorder (PTSD) Checklist was completed after 6 months. Questionnaires were distributed to adult patients with a confirmed diagnosis of SARS-CoV-2 virus infection during their quarantine in Egypt. There was no significant difference between the two groups regarding anxiety and depression during the acute infection. Patients without CMI relied significantly on the use of informational support to cope with COVID-19 disease. Patients with CMI continued to show significant depressive symptoms after 6 months without significant PTSD symptoms. COVID-19 has similar immediate psychological impact on patients with and without CMI. However, patients with CMI continue to show depression on long-term follow-up. [ABSTRACT FROM AUTHOR]

Objective: To study the prevalence and impact of comorbidities among a cohort of patients with systemic lupus erythematosus (SLE). Methods: This study is retrospective, multicenter including 902 Egyptian patients with SLE. Medical records were reviewed for demographic data, clinical characteristics, routine laboratory findings, immunological profile, and medications. Moreover, SLE Disease Activity Index (SLEDAI), and the Systemic Lupus International Collaborating Clinics/American College Rheumatology Damage Index scores were calculated. Results: Comorbidities were found in 75.5% of the studied group with hypertension and dyslipidemia as the most frequent comorbidities (43.1% and 40.1%, respectively), followed by sicca features, avascular necrosis, diabetes, osteoporosis and renal failure (11.5%,9%, 9%,8.9%, and 7.1%, respectively). Multivariate regression model showed statistically significant relation between the presence of comorbid condition and each of age (P = 0.006), disease duration (P = 0.041), SLEDAI at onset (P < 0.001), cyclophosphamide intake (P = 0.001), and cumulative pulse intravenous methylprednisone (P < 0.001). Also, when adjusted to age and sex, those with multiple comorbid conditions had 18.5 increased odds of mortality compared to those without comorbidities (odds ratio (OR), 95% confidence interval (CI) = 18.5 (6.65–51.69)]. Conclusion: Patients with SLE suffer from several comorbidities, with an increasing risk with age, longer disease duration, higher SLEDAI at onset, cyclophosphamide intake and cumulative pulse intravenous methylprednisone. Risk of mortality is exponentiated with multiple comorbidities. [ABSTRACT FROM AUTHOR]

Background: Covid-19 has impacted the lives of individuals worldwide especially those with chronic illnesses. Children with type 1 diabetes (T1DM) are at risk of glycemic deterioration during the Covid-19 pandemic. However, some studies reported glycemic improvement in these children during the pandemic. Aim: To assess the impact of Covid-19 on glycemic control and acute complications among children with T1DM on insulin pump in Egypt. Methodology: Forty-two children with T1DM on insulin pump for at least 1 year were assessed during the period from June 2020 to May 2021 for insulin requirements, insulin-pump problems, frequency of diabetic-ketoacidosis (DKA), hypoglycemia and HbA1C. Continuous-glucose monitoring was done using Medtronic i-pro device for 5 days. Data were compared to those obtained from the patients' medical records 1 year previously. Result: Upon comparing data during Covid-19 pandemic with previous data from 12–24 months before Covid-19, there was a significant small increase in the mean total daily insulin dose from 0.83 ± 0.28 to 0.88 ± 0.30 U/kg/day with a similar small increase in the mean basal percentage from 51.19 ± 3.46 to 52.74 ± 4.31. Interestingly, the median time in range showed small increase from 53 (IQR 47–61) to 57.0 (IQR 51–73), the mean coefficient of variation showed small decrease from 42.10 ± 9.90 to 38.20 ± 8.12 and the mean HbA1C significantly decreased from 8.8 ± 1.3 (72.31 ± 16.78 mmol/ml) to 7.8 ± 1.2 mg/dl (61.31 ± 16.62 mmol/mol). Twenty-nine children (69%) had insulin-pump problems in the form of skin irritation (31%), skin infection (7.1%) and pump Set/Site occlusion (31%). Conclusion: No safety issues and overall glycemic improvement were reported among the children with T1DM on insulin pump therapy from this single center during the covid-19 pandemic. [ABSTRACT FROM AUTHOR]

BACKGROUND: Sensorineural hearing loss is the most common type of permanent hearing impairment and results in postural control and motor deficits in children that may affect or delay all developmental indicators. OBJECTIVE: The purpose of the study was to objectively investigate the consequences of sensorineural hearing loss concerning postural control in pediatrics. METHODS: Forty students of both genders, ages ranging from 10 to 16 years, diagnosed with severe to profound sensorineural hearing loss, were selected from the Public School for the Deaf and Hard of Hearing in El-Minia district, Egypt. The outcome was assessed by HUMAC Balance System and Bruininks-Oseretsky Test (BOT-2) subtest (5) for balance. RESULTS: Regarding HUMAC Balance System and subtest (5) of BOT-2, there was a statistically significant difference between the scores of study subgroups and the counterpart normal subgroups of the same age and gender where p-value equal 0.0035 or less. CONCLUSION: The findings of this study suggest that children with sensorineural hearing loss have a defect in their postural control skills compared to normal children of the same gender and age groups according to HUMAC Balance System and Bruininks-Oseretsky scale. [ABSTRACT FROM AUTHOR]

Background: Patients with peripheral neuropathy (PN) have subtle central pathology that might contribute to cognitive impairment. P300 is a cognitive potential that is connected to both sensory and cognitive processes. Subjects with neurocognitive disorders have considerably longer P300 latency. This study aims to investigate P300's potential as a marker of early-stage cognitive deterioration in PN patients and also, the effect of gender on P300 in patients with PN. Results: A study group of 60 subjects with PN of various etiologies and no other neurological conditions was included, in addition to, a control group of 40 volunteers with normal hearing sensitivity and no central or peripheral auditory neurological abnormalities. P300 response showed significant delayed latencies in study group when compared to control group. Male group had significant delayed P300 latencies in comparison to female group. As regard P300 amplitude, male group showed no statistically significant differences in comparison to female group. Conclusions: Although patients with PN apparently have normal cognitive function, the results in this study revealed the possibility of subtle cognitive impairment. Cognitive functions are affected in both axonal PN and demyelinating PN, however there were no differences found between the two subgroups. Auditory evoked potentials, particularly P300 can be used easily for early detection of subclinical cognitive impairment before appearance of any neurological manifestations. P300 latencies are more important than amplitudes and may be used alone or in addition to amplitudes in cognitive function assessment. [ABSTRACT FROM AUTHOR]

Oropharyngeal dysphagia is a swallowing disorder characterized by difficulty in transferring foods and/or liquids from the oral cavity to the stomach, affecting safe oral feeding. The main complications caused by dysphagia are tracheobronchial aspiration, pneumonia, malnutrition, and dehydration. Fibre-optic endoscopic evaluation of swallowing (FEES) is the first choice for studying swallowing disorders, it is easy to use, very well tolerated, allows bedside examination, and is economic. The dysphagia handicap index (DHI) is a 25-item self-administered questionnaire. It is a noninvasive tool measuring the handicapping effect of dysphagia in three aspects: the physical, functional, and emotional aspects of life, so a patient can rate the impact of his swallowing problem. The aim of this study is to test the correlation between DHI scores and fibre-optic endoscopic examination of swallowing and the ability of DHI to predict penetration and aspiration. For all patients, FEES examination was done as an assessment tool for dysphagia and DHI. Testing the correlation between DHI scores and penetration and aspiration on FEES results in a positive significant correlation, so we can apply DHI as a predictor of aspiration and penetration at medical centres where FEES examination is not accessible. [ABSTRACT FROM AUTHOR]

Simple Summary: Egypt has the highest prevalence of hepatitis C infection in the world with a dramatic increase in the incidence of hepatocellular carcinoma (HCC) observed during the last decade. Currently, HCC is the most prevalent cancer in men and the second most prevalent cancer in women in Egypt. There are limited published data on the implication of host KIR genotypes and the progression of chronic hepatitis C virus (HCV) infection to HCC. We describe the first analysis of Egyptian KIR genotypes from the Nile Delta region. The findings of this study suggest that KIR haplotype AA, that contains dominantly inhibitory genes, was less frequent in HCC patients compared to chronic HCV patients and healthy control subjects. Therefore, haplotype AA may have a crucial role in host defense against HCC progression. In Egypt, hepatocellular carcinoma (HCC) is the most prevalent cancer in men and the second most prevalent cancer in women. In addition, Egypt has one of the highest prevalences of hepatitis C infection in the world. The aim of the present work was to study the potential role of the 16 KIR genes in the outcome of individuals with chronic hepatitis C virus (HCV) infection in Egypt. The study was carried out under an IRB-approved protocol. Sequence-Specific-Primer-PCR (SSP-PCR) was used for KIR genotyping of germline DNA extracted from peripheral blood leukocytes or from the non-tumor liver of 83 HCC patients, 100 patients with chronic HCV infection without HCC, and 120 matched healthy controls. Out of the 83 HCC patients, only 7 (8.4%) were treated by interferon and/or interferon Ribavirin combination, while for the remaining patients 50 (60.2%) received no prior HCV therapy and 26 (31.3%) were treated with direct-acting antiviral (DAA). Our results showed that KIR haplotype AA that contains more inhibitory KIR genes and fewer activating genes was observed with a significantly lower frequency in HCC patients (6/83, 7.2%) compared to chronic HCV (27/100, 27.0%) (p = 0.0005, OR = 0.21 [0.08–0.53]) and healthy controls (29/119, 24.4%) (p = 0.001, OR = 0.24 [0.09–0.61]). In addition, the frequency of genotype 6 (G6) which contains all the KIR genes was significantly high in the HCC patients (16/83, 19.3%) compared to chronic HCV (8/100, 8.0%) (p = 0.02, OR = 2.7 [1.11–6.79]) and healthy controls (8/119, 6.7%) (p = 0.006, OR = 3.31 [1.35–8.16]). Activating KIR genes 2DS1 and 3DS1 were significantly higher in HCC patients (48/83, 57.83% and 45/83, 54.22%) compared to the chronic HCV patients (36/100, 36% and 34/100, 34%), p = 0.028, 0.027, respectively. Our results are contrary to a prior work on HCC from patients with HCV who were mostly treated by interferon-based therapies. In conclusion, KIR haplotype AA has an important role in host defense against HCC progression especially in patients treated by DAA, suggesting an important role of the KIR genotype status on the outcome of chronic HCV infection. [ABSTRACT FROM AUTHOR]

Context: Upper limb activities require a repetitive movement of the shoulder external rotator and abductor muscles. The malfunction of the proximal part of the upper limb kinetic chain tends to change the mechanics of the distal part and increase the risk of injuries. Objectives: To compare the normalized eccentric peak torque (NEPT) of the shoulder external rotator and abductor muscles among healthy athletes and those with tennis elbow and golfer's elbow. Design: An experimental cross-sectional study. Setting: Isokinetic laboratory, Faculty of Physical Therapy, Cairo University. Participants: A total of 30 male athletes participated voluntarily in this study. Intervention: Participants were distributed into 3 groups: healthy group, tennis elbow group, and golfer's elbow group. Main Outcome Measures: NEPT of shoulder abductors and external rotators. The Biodex Isokinetic Dynamometer was used to measure the variables of interest. Results: There was a significant increase in the NEPT of shoulder abductors and external rotators in healthy control group compared with both tennis elbow and golfer's elbow groups at an angular velocity of 60°/s (P <.05). Moreover, there was a significant increase in the NEPT of shoulder external rotators and abductors at an angular velocity of 120°/s in healthy control group compared with tennis elbow group and in golfer's elbow group compared with tennis elbow group (P <.05). Conclusion: Tennis elbow and golfer's elbow are associated with decreased NEPT of shoulder external rotators and abductors compared with those of healthy athletes. This tends to decrease the external stability of the shoulder joint and put high stress on the distal joints of the upper kinetic chain. [ABSTRACT FROM AUTHOR]

Background: Dental caries is one of the most common diseases of childhood. Evidence suggests that malnutrition and vitamin deficiency may increase the risk to dental caries. Aim: This study aimed to determine the relationship between vitamin D and dental caries experience in children and whether vitamin D deficiency is a risk factor for tooth decay. Participants and methods: A cross-sectional study was performed on 51 Egyptian children, aged from three to five years and diagnosed from Abo El-Resh Children's Hospital as 'Sufficient', 'Insufficient' or 'Deficient' in vitamin D. Children were divided into 3 equal groups. A structured questionnaire, formed of four sections, was answered by the parents. Dental examination was performed under natural daylight. Caries index (dmf), for each group, was calculated then compared. The study was conducted from July 2019 to January 2020. Associations between dmf and different variables were assessed using independent t-test. Correlation between age and dmf was assessed using Spearman's rank order correlation coefficient. Multiple linear regression model was used to study the effect of different variables on caries. Results: There was a weak positive correlation between age and dmf scores (β = 2.00; 95%CI, 0.73:3.26). Children playing outside experienced higher dmf (β = 1.29; 95%CI, -0.35:2.94) than those with no outside play. Children with 25(OH) D below 20 ng / ml had the highest dmfs (β = 1.01; 95%CI, -0.74:2.76). There was a significant association with teeth brushing; children not brushing their teeth showed significantly higher dmf (β = -2.21; 95%CI, -4.14:-0.28) than their counterparts. There were no significant associations of sex (β = -1.05; 95%CI, -2.68:0.59), fluoride tablets intake (β = 2.19; 95%CI, -1.25:5.63), dental visits (β = -1.43; 95%CI, -3.09:0.23), mothers' vitamin D intake during pregnancy (β = 0.71; 95%CI, -1.13:2.56), snacking (β = -1.18; 95%CI, -4.62:2.26) and parental education (β = 0.62; 95%CI, -1.18:2.42) with caries experience among the study population. Conclusion: Vitamin D deficiency does not seem to be associated with dental caries experience of 3–5 years old Egyptian children. Out of the indicator variables, age and tooth brushing contributed significantly to the occurrence of dental caries among the study population. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Psoriasis is a common, multifactorial, chronic inflammatory disorder that affects the skin and is increasingly recognized to be a systemic inflammatory disease. The quality of life is significantly affected by the highly heritable polygenic condition known as psoriatic arthritis (PsA). The care of PsA and early identification and detection of the condition will enhance quality of life and reduce complications. Detection of serum biomarker for PsA may help in early diagnosis. Objective To compare the serum levels of matrix metalloproteinase-3 (MMP-3) in patients with psoriasis with and without PsA and its correlation with disease severity. Patients and methods This case-control study was conducted on 40 patients with psoriasis and 20 agematched and sex-matched controls. Patients were divided according to CASPAR criteria into two groups: psoriasis group (A) and PsA group (B). Enzyme-linked immunosorbent assay was used to determine the serum level of MMP-3. Results There was no statistically significant difference of MMP-3 level between psoriatic without PsA and control groups. There was a statistically significant higher level of MMP-3 in the PsA group compared with both psoriatic and control groups (mean=33.20±26.86, 16.24±14.80, and 16.47±8.43 pg/ml, respectively), and it was not correlated with disease severity in patients with psoriasis. Conclusion Serum levels of MMP-3 were significantly higher in psoriatic patients with arthritis compared with both psoriatic and control groups. Therefore, it may have a role in the development of PsA and may be used as a marker for diagnosis; however, it is not correlated with disease severity. [ABSTRACT FROM AUTHOR]

Background Hepatitis C virus (HCV) infection is the most challenging public health problem in Egypt where the prevalence is the highest in the world. Intrafamilial transmission of hepatitis C occurring between patients infected with HCV and their household members sharing the same house and living conditions. Preventive measures of hepatitis C are considered the first line of defense against HCV infection. Aim assess the intrafamilial transmission risk factors and preventive measures followed by household contacts of hepatitis C patients. Design A descriptive cross sectional research design was utilized. Setting The study was conducted at outpatient clinics of Liver Institute at Kafer-Elsheikh Governorate. Sample A simple random sample of 365 household contacts of hepatitis C patients was recruited for the current study. Tool Data was collected through one tool: A structured Interviewing Questionnaire for household contacts of hepatitis C patients which included three parts; part I-(a) Demographic data, (b) Medical history of household contacts, Part II (a) Household contacts knowledge about HCV (b) Hepatitis C risk factors, Part III: Preventive measures followed by household contact of hepatitis C patient: This part is self-reported practices. Results The study revealed that;56.7% of household contacts were males, 72.1% of them were living in rural areas, 75.60% were married, with a mean age ±SD 36.73±9.18 years old.44.1% obtained secondary education, 30.7% were employees, among this group hypertension and diabetes were the main chronic illness. 49.90% had moderate level of general knowledge about HCV infection, 71.50% had low level of knowledge about hepatitis C risk factors and 90.00% had a low level of preventive measures (self-reported practices) regarding HCV. There was no correlation between household contacts knowledge about HCV risk factors and their preventive measures(r=0.031 and P=0.549). Conclusion Almost half of household contacts mentioned that they knew intrafamilial risk factors while about half of this group have a misconception about intrafamilial risk factors, while majority of them stated that they knew sharing scissors and clippers as the main intrafamilial risk factors and less than one-fourth of them knew direct contact with infected blood and sharing of special equitoothbrushesth brushes. Household contacts applied some preventive measures such as; Cover the wound with a piece of cloth or gauze, disinfect the site with alcohol or antiseptic solution and frequent and proper hand washing. Recommendations Routine health assessment of household contacts knowledge regarding intrafamilial risk factors and preventive measures therefore health education sessions should be conducted to raise their awareness regarding HCV infection and further research should be conducted on larger samples of contacts. [ABSTRACT FROM AUTHOR]

(1) Background: Type 2 diabetes mellitus (T2DM) and metabolic syndrome are associated with decreased vitamin D. In contrast, high pro-neurotensin (pro-NT) levels are linked with an increased risk of T2DM and cardiovascular disease. We aimed to determine the validity of pro-NT and 25-dihydroxy vitamin D3 levels as predictors for T2DM complications; (2) Methods: One hundred T2DM, and one hundred healthy volunteers participated in this case-control study. Their Pro-NT and 25-hydroxyvitamin D3 levels were evaluated using the ELISA technique; (3) Results: Pro-NT and 25 (OH) vitamin D3 have significant validity and accuracy in T2DM prediction, 84.5%, and 90.5%, respectively (p = 0.001). At a value of <29.5, 25-Hydroxy vitamin D3 showed 88% sensitivity and 93% specificity in predicting T2DM. At a value of >124 Pmol/L, Pro-NT showed 81% sensitivity and 88% specificity in predicting T2DM. At a value of 16.5, 25-Hydroxy vitamin D3 had 78.4% sensitivity and 68.3% specificity in predicting T2DM complications. At a value of >158 pmol/L, Pro-NT predicted T2DM complications with 67.6% sensitivity and 56.0% specificity; (4) Conclusions: 25 (OH) Vit D3 and Pro-NT could identify T2DM patients and predict T2DM complications. More extensive research is required to adequately validate this novel perspective with a large population study. [ABSTRACT FROM AUTHOR]

Introduction: Chronic osteomyelitis (COM) is a devastating infection requiring a multidisciplinary approach, including radiology, microbiology, pathology, and orthopaedic surgery to treat. The present study analysed the bacterial profile causing chronic osteomyelitis and their antibiogram in our region. Patients and methods: This prospective study was done on a consecutive group of patients who underwent surgical debridement for long bone COM. Three to six deep tissue samples were collected during the index debridement for microbiology and one sample for histopathology. Antimicrobial sensitivity testing used an automated bacterial identification system. Gram stain was used to identify the bacteria type from its size, shape, and arrangement of bacterial growth. Results: Intra-operative deep tissue and bone specimens accurately identified causative bacteria in 84.8% of patients. Gram-ve bacilli (GNB) were the most common causative organisms in 51.6% of all growing samples (36.4% isolated G-ve and 15.2% mixed with G + ve). Thirty-three patients (30 males/three females) were included; the mean age at index debridement surgery was 37.1 years. Half of the cohort had no metalwork. The aetiology of COM was post-operative infection in half of the patients. Conclusion: There may be concerning features in our patients' aetiologies and causative organisms; closed fractures turn into COM postoperatively, several unsuccessful attempts, delayed index debridement, and more GNB. Plans need to be applied to break the cycle and improve outcomes. [ABSTRACT FROM AUTHOR]

Hepatitis C virus (HCV) infection remains a major health problem and one of the leading causes of chronic liver disease worldwide. The purpose of this paper was to summarize knowledge about the epidemiology of HCV genotype (GT) 4 infection, similarities and differences with other genotypes, specific problems associated with this genotype, and treatment regimens used to treat GT4-infected patients. We performed an accurate search for literature using the PubMed database to select high-quality reviews and original articles concerning this topic. GT4 with a global prevalence of 8% takes third place, closing the global HCV podium in terms of frequency. However, there are regions where GT4 infections are dominant, such as sub-Saharan and North Africa, and the Middle East. The disease course and complications are generally similar to those of chronic hepatitis C caused by other genotypes, although the faster progression of fibrosis was demonstrated in patients with coexisting schistosomiasis. In the era of interferon-based therapy, GT4-infected patients were described as difficult to treat due to suboptimal response. A breakthrough in the treatment of HCV-infected patients, including those with GT4 infection, was the introduction of direct-acting antiviral drugs. The availability of safe and effective therapy has created a real opportunity for HCV eradication in line with the goal set by the World Health Organization. An example of a country where this is happening is Egypt, where GT4 accounts for more than 90% of HCV infections. There, broad access to therapy has been effectively supported by population-based screening. [ABSTRACT FROM AUTHOR]

Background and Aim: Infection with the hepatitis C virus (HCV) is an endemic public health problem with long-term consequences, especially in Egypt. Egypt has one of the highest incidence rates of HCV worldwide. The current crosssectional study aims to determine how prevalent occult HCV infection is and how it affects the individual's immune response. Materials and Methods: The studied adult patients the study had chronic HCV infection and underwent a combination of sofosbuvir 400 mg plus daclatasvir 60 mg once daily ribavirin regimen for 12 weeks from March to September 2019. Quantitative real-time PCR was used to detect HCV-RNA in the plasma. In addition, Cytometric Bead Array (CBA) technique was used to assess cytokines levels. Results: 31 participants from Misr University for Science and Technology University hospitals outpatient clinics were included in the study. The median levels of cytokines of the included patients were as follow: the median IL-6 was 6.56 (5.7- 7.9) pg./mL, and 19% of the patients had higher serum IL-6 levels. None of the patients had abnormal serum levels 28b. in addition, the median serum NF-κB was 232 (18.7- 609.89), and 29% had high serum NF-κB levels. Six (19.4%) patients had positive occult HCV infection. Patients with occult HCV infection exhibited significantly higher values of serum IL-6 (P<0.001), NF-κB P<0.001), serum AST (P<0.001), ALT (P<0.001), albumin (P<0.001), and total bilirubin (P<0.001). Conclusion: We support the evidence about the significant association between occult HCV infection and impaired immunological response in patients who achieved sustained viral response (SVR) following direct-acting antivirals (DAA) regimens. [ABSTRACT FROM AUTHOR]

BACKGROUND: Rheumatoid arthritis (RA) disease activity, associated comorbidities, and therapy-related side effects impair the physical, social, and emotional dimensions of the patient's health. Presently, the ongoing COVID-19 pandemic has been associated with a broad range of psychosocial disorders in various populations. Patients with RA are especially vulnerable to such effects. OBJECTIVES: Detect the prevalence of recent COVID-19 infection among patients with RA, assess depression and anxiety in these patients and their associated factors during the COVID-19 pandemic and their potential relation to disease activity. DESIGN AND METHODS: This is a cross-sectional study conducted on 120 adult Egyptian patients diagnosed with RA during the COVID-19 pandemic. The prevalence of recent COVID-19 infection among the patients was evaluated. The patients underwent psychological assessment using the Hamilton Depression Rating Scale (Ham-D) and the Hamilton Anxiety Rating Scale (Ham-A) to measure levels of depression and anxiety levels. The RA disease activity was assessed using Disease Activity Score (DAS) Das-28-ESR. RESULTS: This study encompasses a total of 120 RA patients. The prevalence of patients with a recent history of COVID-19 infection was 40.8%. Both groups exhibited significantly elevated mean scores on the Das-28-ESR scale and also scored higher on measures of depression and anxiety. Interestingly, the COVID-19 group exhibited a higher percentage of unmarried individuals, had educational attainment below the university level, and were unemployed. Patients with recent COVID-19 had significantly lower numbers of children, higher disease duration, higher Das-28-ESR scores, and elevated depression and anxiety scores. The statistical analysis revealed that the COVID-19 infection and disease duration were significant predictors of depression and anxiety. The results also exhibited that the depression score was positively correlated with age and DAS scores. CONCLUSIONS: It was observed that patients diagnosed with RA revealed a higher prevalence of COVID-19 infection. The occurrence of depression and anxiety was observed to be widespread among patients diagnosed with RA and, more significantly, prevalent in RA patients who had a recent COVID-19 and had a higher level of disease activity. The occurrence of COVID-19 and disease duration were identified as factors that can anticipate the development of depression and anxiety. [ABSTRACT FROM AUTHOR]

In the 1970s, Doris Howes Calloway turned to the need to better understand mild to moderate malnutrition. She led the Nutrition Collaborative Research Support Program (NCRSP), which was designed to look at possible effects of inadequate food intakes on outcomes such as growth, morbidity, pregnancy, and childhood intellectual development. Although it was known that a severe lack of calories and/or nutrients could result in serious morbidity and death, there was controversy about the effects of moderate malnutrition. Although growth might be stunted, it seemed possible that other health and developmental outcomes might not be affected. The NCRSP selected low-income regions of 3 countries (Egypt, Kenya, and Mexico) where there was moderate malnutrition, to evaluate causes and effects on these outcomes. The study found that child growth was compromised in all 3 sites, primarily due to childhood illnesses in Egypt and to poor diets in Kenya and Mexico. Other negative effects were also seen in lower scores on tests of cognitive abilities. The NCRSP results were further extended by new studies of undernutrition both in the original countries sites and in additional locations. Ultimately, the NCRSP led to a greater acceptance of the negative consequences of even moderate malnutrition. [ABSTRACT FROM AUTHOR]

Patients with substance use disorders are at high risk for suicidal ideas and behaviors. Prevention of suicide among these patients should be a public health priority. The objective of this study was to investigate the prevalence and correlates of suicidal ideas and suicide risk among patients with substance use disorders. This study included 100 patients with substance use disorders who sought treatment at Zagazig University hospital, Egypt. All participants were interviewed using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text-Revised and rated by Beck Suicide Scale. Drug-related problems were assessed using the Arabic version of Addiction Severity Index. Urine screen for drugs was done for all patients participated in the study. Twenty-seven percent of the patients with substance use disorders had suicidal ideas, 22% had suicide risk, and 9% had history of suicidal attempts. Females were 5 times more likely to have suicide risk than males. Unemployed patients were three times more likely to have suicide risk than employed or skilled workers. There was an association between suicide risk and heroin use and alcohol dependence and patients with positive family history of suicide.. Suicidal ideas and suicide risk were common among patients with substance use disorders. Female gender, unemployment, heroin use, and alcohol dependence and positive family history of suicide were predictors of suicide ideation and risk in patients with substance use disorders. [ABSTRACT FROM AUTHOR]

Background: Monitoring oxygen saturation in shocked patients is a challenging nursing procedure. Shock syndrome alters peripheral tissue perfusion and hinders peripheral capillary oxygen saturation (SpO2) measurements. Our study aimed to find a solution to this problem. The pharynx is expected to be an accurate SpO2 measurement site in shocked patients. We clinically evaluated the pharyngeal SpO2 measurements against the arterial oxygen saturation (SaO2) measurements. Methods: A prospective cohort research design was used. This study included 168 adult shocked patients. They were admitted to five intensive care units from March to December 2020 in an Egyptian hospital. A wrap oximeter sensor was attached to the posterior surface of an oropharyngeal airway (OPA) by adhesive tape. The optical component of the sensor adhered to the pharyngeal surface after the OPA insertion. Simultaneous pharyngeal peripheral capillary oxygen saturation (SpO2) and arterial oxygen saturation (SaO2) measurements were recorded. The pharyngeal SpO2 was clinically evaluated. Also, variables associated with the SpO2 bias were evaluated for their association with the pharyngeal SpO2 bias. Results: The pharyngeal SpO2 bias was − 0.44% with − 1.65 to 0.78% limits of agreement. The precision was 0.62, and the accuracy was 0.05. The sensitivity to detect mild and severe hypoxemia was 100%, while specificity to minimize false alarm of hypoxemia was 100% for mild hypoxemia and 99.4% for severe hypoxemia. None of the studied variables were significantly associated with the pharyngeal SpO2 bias. Conclusion: The pharyngeal SpO2 has a clinically acceptable bias, which is less than 0.5% with high precision, which is less than 2%. [ABSTRACT FROM AUTHOR]

Background: Thalassemia is one of the commonest single gene disorders usually associated with many complications. Coagulation changes as well as trace elements levels alterations have been described in children with β thalassemia. Activation of coagulation can be assessed by measuring thrombin-antithrombin (TAT) complex, plasmin-antiplasmin (PAP) complex and β-thromboglobulin (β-TG).Methods: A total of 200 children and adolescents were enrolled in the study; 100 were from the Al-Azhar University hospital's pediatric hematology clinic diagnosed as thalassemia major, while the other 100 were apparently healthy volunteers who acted as the control group. Complete blood count, liver function test, kidney function tests, TAT complex, PAP complex, β-TG as indicators of coagulation changes, serum zinc and copper were performed on all participants.Results: Significantly higher levels of TAT complex, PAP complex and β-TG in thalassemia children than the controls. Decreased serum zinc and increased serum copper levels in thalassemia children compared to the controls. A negative correlation was observed between the serum level of TAT and hemoglobin level, besides the negative correlation of TAT complex and β-TG with the serum zinc.Conclusion: Thalassemia major was associated with increased serum level of coagulation activation markers, increased serum copper while decreased serum zinc. [ABSTRACT FROM AUTHOR]

Background: Children with cerebral palsy (CP) are at high risk for dental caries. Alteration of some salivary properties encountered among them compared to healthy children, could play a role in this elevated risk. Objectives: The aim of the present study was to assess salivary physicochemical properties; including total antioxidant (TAC), flow rate, viscosity, pH and buffering capacity, as well as Streptococcus mutans level among children with CP, also to correlate these variables to their caries experience. Materials and methods: This case control study included 80 children with CP, study group (SG) and matched number of healthy children for control group (CG). Interview-based questionnaire, clinical examination, salivary biochemical and microbiological investigations using MALDI-TOF were done. Results: In SG, the caries experience in primary teeth dmft and S. mutans log value were significantly higher than CG (P = 0.039, P = 0.002) while unstimulated salivary flow rate, buffering capacity and salivary TAC were significantly lower (P < 0.0001). Multivariate linear regression showed that the presence of CP was significantly associated with the greatest variation in caries experience in the primary teeth and permanent teeth. Higher unstimulated salivary flow rate, or an increase in buffering capacity by 1 ml of acid/ml of saliva were associated with lower number of the affected primary and permanent teeth. On the other hand, One-unit increase in S. mutans log count and higher salivary TAC were associated with higher caries experience. Conclusion: Children with CP have higher caries experience (dmf) due to lower salivary protective factors and higher S. mutans counts. [ABSTRACT FROM AUTHOR]

Background and Objectives: Acute kidney injury (AKI) is frequent among critically ill children. This study aimed to assess the incidence and factors associated with AKI among children with type 1 diabetes mellitus (T1DM) hospitalized with diabetic ketoacidosis (DKA). Methods: This prospective observational study was conducted at Sohag University Hospital, Egypt over 1 year. Children aged 6 months to 12 years, diagnosed with T1DM and hospitalized with the criteria of DKA were included. The study participants received intravenous fluid therapy and intravenous insulin infusion for DKA management. Serum creatinine levels were measured at admission, 24 and 48 h after admission. AKI was defined and staged using the Kidney Disease Improving Global Outcomes serum creatinine criteria. Results: The study included 265 DKA episodes in 240 participants. AKI was found in 110 (41.5%) DKA episodes. Moderated to severe AKI developed in 41 (15.5%) episodes. Multivariate regression analysis revealed that age (adjusted odds ratio = 0.78, 95% confidence interval (CI): 0.69–0.89, p < 0.001), Glasgow–Coma scale (GCS) < 14 at admission (adjusted odds ratio = 4.66, 95% CI: 1.66–13.14, p = 0.004) and serum chloride level at 12 h (adjusted odds ratio = 1.10, 95% CI: 1.02–1.18, p = 0.01) were the most significant factors associated with moderate to severe AKI development. Conclusions: AKI is common among T1DM children hospitalized with DKA. Younger age, low GCS at hospital admission and increased serum chloride level during DKA management were associated with increased risk for moderate to severe AKI development. [ABSTRACT FROM AUTHOR]

Background: Coexistence of molar pregnancy with living fetus represents a challenge in diagnosis and treatment. The objective of this study to present the outcome of molar pregnancy with a coexisting living fetus who were managed in our University Hospital in the last 5 years.Methods: We performed a retrospective analysis of patients who presented with molar pregnancy with a coexisting living fetus to our Gestational Trophoblastic Clinic, Mansoura University, Egypt from September, 2015 to August, 2020. Clinical characteristics of the patients, maternal complications as well as fetal outcome were recorded. The patients and their living babies were also followed up at least 6 months after delivery.Results: Twelve pregnancies were analyzed. The mean maternal age was 26.0 (SD 4.1) years and the median parity was 1.0 (range 0-3). Duration of the pregnancies ranged from 14 to 36 weeks. The median serum hCG was 165,210.0 U/L (range 7662-1,200,000). Three fetuses survived outside the uterus (25%), one of them died after 5 months because of congenital malformations. Histologic diagnosis was available for 10 of 12 cases and revealed complete mole associated with a normal placenta in 6 cases (60%) and partial mole in 4 cases (40%). Maternal complications occurred in 6 cases (50%) with the most common was severe vaginal bleeding in 4 cases (33.3%). There was no significant association between B-hCG levels and maternal complications (P = 0.3).Conclusion: Maternal and fetal outcomes of molar pregnancy with a living fetus are poor. Counseling the patients for termination of pregnancy may be required.Trial Registration: The study was approved by Institutional Research Board (IRB), Faculty of Medicine, Mansoura University (number: R.21.10.1492). [ABSTRACT FROM AUTHOR]

Background Understanding of polycystic ovarian syndrome (PCOS) and its phenotypes with the heterogeneous manifestations and hormonal armamentarium has been not fulfilled. Objective To elucidate dermatologic manifestations in Egyptian PCOS cohort, association of each manifestation with hormonal change, and relation of these findings with different phenotypes of PCOS. Patients and methods In this case–control study, 95 women who met the criteria of diagnosis of PCOS based on Rotterdam Consensus criteria 2003 and 50 age-matched controls underwent skin examination, anthropometric measurements (height, weight, BMI, and waist circumference), hormonal assays (total and free testosterone, dehydroepiandrosterone sulfate, prolactin, and thyroid-stimulating hormone), and homeostatic model of insulin resistance. Results Women with PCOS showed significantly higher BMI (30.71±5.94 kg/m2), waist circumference (99.94±13.01 cm), prevalence of cutaneous manifestations of hyperandrogenism (HA), total and free testosterone, dehydroepiandrosterone sulfate, and homeostatic model of insulin resistance than controls. Hirsutism was the most prevalent skin finding (45.3%) and was the only one significantly associated with elevated serum androgens. Cutaneous HA overwhelming occurred in 82%, whereas biochemical HA was detected in 55.7 % of patients with PCOS. The prevalence of PCOS phenotypes was A (55.8%), B (8.4%), C (25.3%), and D (10.5%). Cutaneous HA and biochemical HA were the most common in phenotype A and least in phenotype D and intermediate in phenotypes B and C. Conclusion The effect of PCOS on skin seems to be greater than on serum androgen levels. Hirsutism was the most prevalent cutaneous feature and the only major indicator of HA, followed by acne. A small percentage of patients with PCOS can show neither clinical nor biochemical HA. Phenotype A was the most severe, whereas phenotype D was the least severe, and B and C were intermediate forms. [ABSTRACT FROM AUTHOR]

Background Rabies is a highly contagious but still an undervalued zoonotic disease. The disease affects almost all mammals, and infected species will always die owing to the disease once the associated clinical signs appear. Dog-mediated rabies is responsible for 99% of rabies transmission to humans, and as a result, it leads to rabies-related human deaths, despite the fact that canine rabies vaccination is extremely effective and provides protection. Rabies control, prevention, and management necessitates adequate information about community knowledge, attitudes, and practices linked to rabies disease. Aim To assess knowledge, attitudes, and practices toward rabies among visitors of a family health center. Patients and methods A descriptive research design was used. Setting The study was conducted at Abu Al-Saud Family Health Center, Masr El-Kadema medical health sector, Cairo. Sample A convenience sample of 240 visitors of Abu Al-Saud Family Health Center was included. Tools A rabies KAP questionnaire was prepared by the investigators for visitors of the family health center. It consists of 47 questions, including the following four parts: part A, demographic characteristics; part B, knowledge of participants about rabies disease; part C, the three-point Likert scale for attitudes; and part D, assessment of participants' practices after dog bites. Results The current study revealed that all participants were living in urban area and 66.3% of the study participants did not know what rabies is. Regarding participants' attitudes, 82.9% of the study participants agreed that stray dogs were considered a problem in the Egyptian society. Concerning participants' practice, 79.6% of them went to the nearest health facilities to receive health care as a first aid for the wounds caused by a dog or any other animal bite. Conclusion Overall, 98.3% of the study participants had poor knowledge about rabies, 84.6% of them had a negative attitude toward rabies, and 100%of them had unacceptable level of practice regarding dog bites. Recommendation Education health programs should be conducted about rabies disease to improve people's knowledge, attitude, and practice toward rabies. Further research studies should be performed on a larger sample in different community settings across the country with the intention to generalize the results. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease stage 5 (CKD 5) populations have peculiar risk for severe Covid-19 infection. Moreover; pediatric data are sparse and lacking. The aim of this study is to report our experience in CKD 5 children treated by hemodialysis (CKD 5D) and CKD 5 children after kidney transplantation (KTR) during one year of Covid-19 pandemic. Methods: Retrospective analysis of 57 CKD 5 children with Covid-19 like symptoms during 1 year pandemic was performed. A cohort of 19 confirmed patients (13 CKD 5D and 6 KTR) was analyzed in details as regard clinical, laboratory, radiological criteria, management and their short term outcome. Results: Conclusion: Pediatric patients on regular HD (CKD 5D) are at higher risk and worse outcome of Covid-19 infection than KT recipients (KTR). Pre-existing HTN and shorter duration after KT are potential risk factors. Reversible AGD after KT and CVC related infections in HD patients are additional presenting features of Covid-19 infection. [ABSTRACT FROM AUTHOR]

Background: Critical illness due to infective endocarditis (IE) has high in-hospital mortality. Besides being a cause of sepsis, this disease has the potential nature to affect multiple organs. Patients and methods: Data for 84 patients managed at the critical care medicine unit at Cairo University for 7 years were surveyed for IE using modified Dukes criteria. Among the patient group with a verified diagnosis of IE, patient characteristics (age and comorbidities), the grade of diagnosis, the blood culture result, echocardiographic findings, minor diagnostic signs (fever, presence of prosthetic valves and pacemaker, vascular phenomena, immunologic phenomena) and clinical complications (heart failure, septic shock, neurologic complications renal failure) were studied regarding their association to in-hospital mortality. Incidence of clinical complications was compared to the control group with sepsis due to other causes. Results: The mortality rate in the IE group is 18.8%. Factors showing significant association to in-hospital mortality are; septic shock p = 0.01, neurological complications p = 0.025 (especially cerebral hemorrhage p = 0.025), indicated non-performed surgery p = 0.008, and presence of underlying heart failure with reduced ejection fraction (HFrEF), p = 0.002. Incidence of clinical complications showed no significant difference in IE patients and patients with other causes of sepsis except heart failure which showed significantly increased incidence in the IE group, p = 0.004. Conclusion: Septic shock, neurological complications, indicated nonperformed surgery, and presence of underlying HFrEF are in-hospital mortality risk factors in critically ill patients due to IE. In-hospital mortality and clinical complication incidence (except heart failure) are similar to other causes of sepsis. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to evaluate the prevalence of thrombocytopenia in a cohort of patients with primary and secondary antiphospholipid syndrome (APS) and to examine the relation of thrombocytopenia to the clinical, laboratory findings, and damage index for antiphospholipid syndrome (DIAPS). Patients and methods: Between August 2018 and February 2019, a total of 168 patients (16 males, 152 females; mean age: 32.5±8.4 years; range, 18 to 59 years) who were followed in our clinic for APS were retrospectively analyzed. Medical records of the patients were screened and clinical data, laboratory investigations, and treatments applied were recorded. The DIAPS was calculated for all patients. The patients were divided into two groups according to the presence or absence of thrombocytopenia and both groups were compared regarding clinical, laboratory findings and DIAPS. Further subgroup analysis was done for patients with primary APS. Results: The most common clinical manifestations in our patients were obstetric manifestations (77.4% in pregnant women), musculoskeletal manifestations (69%) and peripheral vascular thrombosis (54.8%). The prevalence of thrombocytopenia in our study was 42.3%, and it was significantly associated with musculoskeletal manifestations (p=0.043), vascular thrombosis (p=0.043), neurological manifestations (p=0.030), cutaneous manifestations (p=0.006), and use of immunosuppressives (p=0.047). The DIAPS was significantly higher in the thrombocytopenia group (p=0.034). Further subgroup analysis of patients with primary APS revealed that neurological manifestations (p=0.010) were significantly higher in the thrombocytopenia group, while the DIAPS was higher in the thrombocytopenia group, but it did not reach statistical significance (p=0.082). Conclusion: Thrombocytopenia may be associated with a higher incidence of vascular thrombosis, neurological manifestations, musculoskeletal manifestations, use of immunosuppressive treatment, and DIAPS. In primary APS patients, thrombocytopenia may be a risk for neurological manifestations. [ABSTRACT FROM AUTHOR]

The study spotlights a severe uncommon post‐burn complication, Marjolin's ulcer, in upper Egypt plastic and wound care centres. This problem is mainly related to inadequate medical care and awareness. No community or race is immune. The underlying malignant transformation mechanism remains unclear. The study aims, according to our experience, to review the prognostic factors through the management protocol of Marjolin's ulcers. This prospective study was conducted in the Aswan University Plastic & Burn surgery department in South Egypt between 2013 and 2020 and investigated 226 patients with chronic post‐burn ulceration. Nineteen cases were proved to have Marjolin's ulcer, and the other cases that had been excluded from being malignant went for reconstruction with split‐thickness skin graft with/without flap after adequate ulcer debridement. The surgical, oncologic, radiologic indications, and prognostic factors were reviewed according to our management outcome—the assessment with follow‐up period extended over 5 years. Histopathology of ulcers ranged among mild, moderate, and poorly differentiated squamous cell carcinoma. One scalp ulcer case showed basosquamous pathology. Most cases presented at age above 50, but no age was immune. The mean latent period was 29 years on average. The lesions' sites varied in their anatomic location where they involved the upper extremity, the scalp, and the lower extremity that had a predilection. Although surgical excision is the primary management line for tumour ablation, other factors may change the management course. During the follow‐up period, neoplasm recurrence in the form of lymph node enlargement and/or locoregional metastasis was detected in eight cases. Within 1 year after the intervention, six recurrent cases died, and two were saved. In addition to the case study, this paper reviewed the literature and provided our team a good experience in light of the NCCN protocol for non‐melanotic cutaneous carcinoma, although we suffered limited medical resources. It is concluded that early accurate diagnosis, low‐grade malignancy, and well‐planned individualised surgery with adjuvant radiotherapy were the best prognostic factors. The close follow‐up for an early sign of disease recurrence is paramount. [ABSTRACT FROM AUTHOR]

Objective: To identify risk factors and assess diabetic foot ulcer (DFU) and amputation risk category (according to the 2015 International Working Group on the Diabetic Foot (IWGDF) guidance) among patients with type 2 diabetes in the Suez governorate, Egypt. Method: A cross-sectional study was conducted in the diabetic foot screening clinic of Suez General Hospital. A comprehensive sample of patients with type 2 diabetes attending the diabetes clinic every Saturday were enrolled in the study. Patients were divided into four groups according to their history and foot examination: without neuropathy (Group 0); with neuropathy (Group 1); with neuropathy associated with deformity and/or vascular disorders (Group 2); and with foot ulcer or amputation history (Group 3). Results: A total of 220 patients were included in the study. Mean age of participants was 54.6±10.3 years and 70.5% of patients were female. The patients were divided into four groups: 37.3% were in group 0; 37.7% in group 1; 11.8% were in group 2; and 13.2% were in group 3. Male sex and diabetic complications (particularly neuropathy, cardiovascular disease and retinopathy) had the most significant effect on risk classification. Conclusion: This study showed that 62.7% of patients with diabetes enrolled in the study were at risk of developing a DFU and amputation. Physicians should conduct a foot assessment and risk categorisation for all patients with diabetes as early management or referral could prevent further complications. [ABSTRACT FROM AUTHOR]

Background: Palliative care is comprehensive supportive care addressing the suffering, pain, discomfort, symptoms, and stress of cancer and any serious life-threatening disease. It is a key part of care for our children living with cancer and is an important source of support for their families. The study aimed to assess the perception of pediatric oncology family care providers toward palliative care and its perceived barriers in Egypt.Method: Total number of 500 oncology children's family care providers was recruited. A descriptive research design was utilized. Researchers used three tools as Structured Interview Questionnaire to assess the participants' knowledge and perceived barriers, Attitude toward palliative care Likert Scale, and Reported Practices Observational Checklist. The study was conducted in outpatient cancer clinics affiliated with El-Nasr governmental hospital located at Port Said governorate.Results: 51.8% of the total oncology children's family care providers had sufficient knowledge, 78.6% had a positive attitude, while,76.8% of them had inappropriate Practice towards palliative care.Significance Of Results: The pediatric oncology family care providers had sufficient knowledge and a positive attitude toward palliative care, but their practices were inappropriate. Also, the majority of participants identified Lack of family care providers training in pediatric palliative care and improper communication between the health team and family care providers as the main barriers to providing palliative care to children. Providing a palliative care training program for family caregivers through continuing professional development is highly recommended besides further research studies using large probability samples at different settings. [ABSTRACT FROM AUTHOR]

The landscape of chronic liver disease in Egypt has drastically changed over the past few decades. The prevalence of metabolic-associated fatty liver disease (MAFLD) has risen to alarming levels. Despite the magnitude of the problem, no regional guidelines have been developed to tackle this disease. This document provides the clinical practice guidelines of the key Egyptian opinion leaders on MAFLD screening, diagnosis, and management, and covers various aspects in the management of MAFLD. The document considers our local situations and the burden of clinical management for the healthcare sector and is proposed for daily clinical practical use. Particular reference to special groups was done whenever necessary. [ABSTRACT FROM AUTHOR]