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Abdihamid Hassan Hilowle,1 Abdikarim Hussein Mohamed2,3 1Department of Urology, Mogadishu Urological Center, Mogadishu, Somalia; 2Department of Urology, University of Somalia, Mogadishu, Somalia; 3Department of Urology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Abdikarim Hussein Mohamed, Tel +252615167182, Email abdikarimgabeyre@uniso.edu.soObjective: Very limited data are available exploring the potential influence of gender on Retrograde Intrarenal Surgery outcomes. This study investigates the gender-specific influence of ShuoTongureteroscopy (ST-urs) and Flexible Ureteroscopy (F-urs) surgeries on operation efficacy and patient recovery in a sample of the Somali population.Materials and Methods: We enrolled 390 participants. Participants were stratified into four gender-specific subgroups based on ureteroscopy operation type: 27.7% males in S-urs (group1), 44.4% females in S-urs (group2), 18.7% males in F-urs (group3), and 9.2% females in F-urs (group4). Primary outcomes included operation time, postoperative hospital stay duration, and VAS Pain Score. Multivariate logistic regression was used to assess associations.Results: The mean age was 29.53 ± 7.61 years, 72.1% male and 27.9% female, with 46.4% of the patients undergoing ST-urs and 53.6% undergoing F-urs. Women had higher odds of prolonged hospital stays (OR = 2.62, 95% CI: 1.43– 4.82, p < 0.001) and post-operation pain (OR = 5.06, 95% CI: 2.95– 8.68, p = 0.002). Among men who underwent F-urs procedure, there was a significantly higher odds ratio (OR) of 6.14 (95% CI: 2.86– 13.19, p < 0.001) for experiencing a long operation time. Conversely, for females, those who underwent S-urs surgery had a notably lower OR of 0.32 (95% CI: 0.13– 0.79, p = 0.013) for long operation time, whereas those who underwent F-urs surgery exhibited a substantially elevated OR of 5.36 (95% CI: 1.85– 15.53, p < 0.001). Both females undergoing F-urs surgery (OR: 5.16, 95% CI: 2.61– 10.21, p < 0.001) and those undergoing F-urs surgery (OR: 5.25, 95% CI: 2.17– 12.73, p < 0.001) experienced significantly higher post-operative pain.Conclusion: Our research reveals gender disparities in retrograde intrarenal surgery outcomes. Women experience longer hospital stays and higher postoperative pain levels compared to men. F-urs procedures are associated with longer operation times and hospital stays, particularly affecting women. Contrarily, ST-urs offers shorter operation times for women but leads to prolonged hospital stays and heightened postoperative pain.Keywords: ureteroscopy, gender-specific, Flexible ureteroscopy, ShuoTong

Abdihamid Hassan Hilowle,1 Abdikarim Hussein Mohamed2 1Urology Department, Mogadishu Urological Center, Mogadishu, Somalia; 2Urology Department, University of Somalia, Mogadishu, SomaliaCorrespondence: Abdikarim Hussein Mohamed, Tel + 252615167182, Email abdikarimgabeyre@gmail.comObjective: To assess the correlation of attenuation value measured as HU in Non-contrast computed tomography, stone size, location, fibre size and stone composition with Holmium: yttrium-aluminium garnet (Ho: YAG) laser parameters including, cumulative laser energy and final laser time.Materials and Methods: We prospectively analyzed 118 patients undergoing flexible/semirigid ureteroscopy and Holmium: YAG laser lithotripsy from October 2022 to October 2023 at Mogadishu Urological Centre. Our study parameters encompass preoperative stone characteristics determined in NCCT (stone size, attenuation value, and stone location), fibre size, cumulative laser energy and time, overall operative time, and postoperative stone composition analysis.Results: There were 118 patients eligible for our prospective study. In the logistic regression model for retrograde intrarenal surgery with a fibre size of 272 μm, cumulative laser energy showed a significant difference among stone size, location, fibre size, and calcium oxalate stones (P > 0.05). However, no significant difference was noticed in the attenuation value (P = 0.078) (R2 = 0.053). Our analysis showed a positive significance among all the parameters (P < 0.05) for laser time. In logistic regression for a rigid ureteroscope with a fibre size of 365 μm, cumulative laser energy showed a significant difference between the location stone and fibre size (P < 0.05) (R2 = 0.09). However, no significant difference was seen among stone size, attenuation value, and calcium oxalate stones (P > 0.05). For laser time, our analysis showed a positive significance among all parameters except the calcium oxalate stones, which showed no significant difference (P > 0.05).Conclusion: Our study showed that stone location, hardness, and fibre size are the most critical factors influencing the outcome of Ho: YAG laser parameters. The study revealed that CaOMH stones require more time to disintegrate into smaller ones, while PH-dependent stones such as carbonate apatite may require less time to fragment.Keywords: stone size, attenuation, stone density, Ho: YAG laser, cumulative laser energy

Abdikarim Hussein Mohamed,1 Mohamed Osman Omar Jeele2 1Urology Department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia; 2Internal Medicine Department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Abdikarim Hussein Mohamed, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia, Tel +252 61 516 7182, Email abdikarimgabeyre@gmail.comBackground: End-stage renal disease (ESRD) in Somalia remains unexamined due to a lack of a national registry system, and the impact of the disease in the country is not estimated yet. The present study is the first report that aims to evaluate the epidemiological characteristics, causes, and dialysis-related factors associated with readmissions in ESRD patients who were going to routine hemodialysis.Patients and methods: This cross-sectional observational study enrolled 208 patients with ESRD. Also, this study investigated patients readmitted to the hospital (n=135) after they enrolled in hemodialysis. The sociodemographic characteristics, risk factors, and comorbidities associated with these patients were reviewed. Admission site, length of hospital stay, outcome, and dialysis-related factors associated with readmissions in the first six months after being on a regular hemodialysis program were also assessed.Results: The mean age of the patients was 52.7± 15.0 years, 43.3% were > 60 years, and 61.5% were male. The most common cause was diabetes at 39.4%, followed by hypertension (35.6%) and 12.5% for postrenal obstruction. The prevalence of 6-month hospital readmissions was 65%. The most common dialysis-related factor associated with readmissions was uremic complications due to missed hemodialysis sessions (40%), vascular access/catheter infection (20%), and anemia (17.8%) (95% CI: 0.825– 5.357, OR: 3.017, p< 0.04). Female cases were more vulnerable to vascular catheter site infection, anemia, and hyponatremia (p< 0.001). 27.5% of the patients were admitted to the intensive care unit (ICU), and the most common reason for ICU admissions was pulmonary edema (53.8%), sepsis (42.8%), and uremia due to hemodialysis skip (26.4%) (95% CI: 1.507– 13.632, OR: 2.08, p=0.01). The mortality rate was 5.2%.Conclusion: The prevalence of unplanned hospital readmissions within six months was very high, and a missed hemodialysis session was identified as the leading cause. Inadequate knowledge, wrong social beliefs about the concept of dialysis and a lack of a health insurance system that covers the higher costs of each dialysis session are believed to be the causes of missed dialysis occasions.Keywords: end-stage renal disease, Sub-Saharan Africa, hemodialysis

Abdikarim Hussein Mohamed,1 Ismail Mohamud Abdullahi,2 A&scedil;&inodot;r Eraslan,1 Hussein Ali Mohamud,1 Metin Gur1 1Urology Department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia; 2Pathology Department, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Abdikarim Hussein Mohamed, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia, Tel +252615167182, Email abdikarimgabeyre@gmail.comBackground: There is a scarcity of studies regarding renal cell carcinoma (RCC) reported from Sub-Saharan Africa.Objective: The present study is the first report evaluating the prevalence and clinical and histopathological features of RCC at a tertiary hospital in Somalia.Methods: This retrospective study included 84 patients with histologically confirmed RCC over 5-years. The investigated parameters were sociodemographic features, radiological and histopathological characteristics, mortality, and overall 5-year survival rate.Results: The prevalence of RCC in our study was 0.7%. The mean age of the patients was 53.74± 5.5 years, 67.9% were male, and 32.1% were female, with a 2:1 male-to-female ratio. The mean tumor size was 6.38± 2.4 cm. Clear cell RCC was the most common histological type in 67.8%, followed by papillary RCC (15.6%), unclassified RCC (9.5%), and chromophobe RCC was the least common in 7.1% of the cases. About one-third of the case had locally advanced RCC with positive nodal involvement, 26.2% of the patients had metastatic disease, and a further 6% progressed to metastatic cancer despite surgical resection. Eight percent of our cases returned with local recurrence. The mortality rate was 37.2%. More than eighty percent of females had a low-stage and a low-grade RCC, while males held higher stages and higher grades RCC in 37% and 63%, respectively (p< 0.001). Smokers were male-only, while obesity was common in female patients (p=0.02).Conclusion: The study findings showed a satisfactory outcome, 71.4% of our patients presented with localized RCC, the five-year survival rate of the patients was 62.8%, and the mortality rate was substantially higher for patients with a higher stage, a higher grade tumor, and metastatic disease at the time of diagnosis.Keywords: renal cell carcinoma, Sub-Saharan Africa, mortality, five-year survival rate

Ahmed Muhammad Bashir,1 Abdirashid Hashi Mohamed,1 Hawa Nuradin Mohamed,1 Ismail Gedi Ibrahim2 1Internal Medicine Department, Mogadishu Somali Turkey, Recep Tayyip Erdogan, Training and Research Hospital, Mogadishu, Somalia; 2Radiology Department, Mogadishu Somali Turkey, Recep Tayyip Erdogan, Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Ahmed Muhammad Bashir, Internal Medicine Department, Mogadishu Somali Turkey, Recep Tayyip Erdogan, Training and Research Hospital, Mogadishu, Somalia, Email ambashir@hotmail.comBackground: It is extremely rare for hypercalcemia to appear as the first symptom of hepatocellular carcinoma. Instead, it occurs primarily as a paraneoplastic manifestation after the disease is already diagnosed.Methods: In this report, we describe a 55-year-old woman who presented with symptoms of acute severe hypercalcemia and was negative for hepatitis B surface antigen and hepatitis C virus antibodies.Results: Laboratory tests confirmed hypercalcemia (serum calcium 16.2 mg/dL) with intact parathyroid hormone (2 pg/mL). Alpha-fetoprotein serum level was 3031.14 ng/mL. Abdominal ultrasonography and computed tomography revealed a big vascularized mass of 7 × 5.5cm in diameter, occupying most of the right lobe of the liver.Conclusion: Based on these findings, hepatocellular carcinoma may present late in disease progression with isolated hypercalcemia; therefore, HCC should be considered in the differential diagnosis in a hypercalcemic patient.Keywords: hypercalcemia, hepatocellular carcinoma, Somalia

Abstract Background Oculocutaneous albinism type1 (OCA1) is caused by the TYR gene's homozygous and compound heterozygous variants. TKFC gene variants cause triokinase & FMN cyclase deficiency syndrome with variable multisystemic disorders. Objectives To determine the potential disease-causing variants in two deceased patients presenting atypical OCA1 features by demonstrating three generations for a single family. The two deceased neonates had severe skeletal abnormalities and fatal hypertrophic cardiomyopathy. We also explored the potential mechanisms for the causative relationship between TKFC and multisystem disorders. Patients and methods Due to the new emerging symptoms that weren’t reported before with the TYR gene, the following methods were performed: Sanger sequencing for the TYR gene, followed by whole exome sequencing, co-segregation, and computational analyses. Results Extensive parental consanguinity was found, and consequently an autosomal recessive mode of inheritance was prioritized. Upon performing sequencing and segregation data, the following has been confirmed: positive co-segregation of nonsense homozygous NM_000372.5:c.346C > T p.(Arg116*) variant in TYR gene and multisystem disease-missense homozygous NM_015533.4:c.598G > A p.(Val200Ile) variant in TKFC gene in the two affected index patients who deceased due to hypertrophic cardiomyopathy. Using computational analysis, we found that c.598G > A p.(Val200Ile) pathogenicity has led to the failure of L2-K1 active site closure due to the potential differential fluctuation between valine and isoleucine residues. Subsequently, disruption of endogenous DHA phosphorylation was found. Two potential mechanisms exploring the causative relationship between TKFC gene and multisystem disorders have been suggested. Conclusions This study presented a first family with the co-existence of biallelic variants in TYR and TKFC genes associating severe skeletal abnormalities and lethal hypertrophic cardiomyopathy. Neither of these genes would have been pursued in the standard genetic counseling. Such discovery is paving the way for more efficient genetic counseling. Comparing TKFC results with literature data showed that our relevant expanded TKFC variant is the 3rd worldwide.

Abstract Background The use of IOUS is increasingly common in recent neurosurgical practice. IOUS has become very valuable in neurosurgery. It plays a key role in the localization of space-occupying lesion location and decreasing operation time and hence improves both surgical efficiency and safety. Ultrasound is very useful in the determination of the lesion location, its most superficial portion, and in differentiation between solid tumors and cystic components. Results Intraoperative ultrasonography has a significant edge over the other intraoperative aids for image guidance in brain surgery, especially in terms of independence, cost, and adaptability to multiple different clinical scenarios. Ultrasound-based neuro-navigation is an easy-to-use, fast, and safe technique of real-time imaging for various neurosurgical procedures. Conclusion We conclude that ultrasound-based neuro-navigation is an easy-to-use, fast, and safe technique of real-time imaging for various neurosurgical procedures.

Abstract Background Cardiac symptoms are a characteristic feature of chronic obstructive pulmonary disease (COPD), a disorder with lately achieved recognition as a systemic illness according to established standards. The research’s objective was aimed at investigating the transthoracic echocardiography role in assessing right ventricular (RV) dysfunction among individuals diagnosed with COPD, as well as to examine the potential correlation between blood pro B-type natriuretic peptide (BNP) concentrations + and this diagnostic procedure. Methods Arterial blood gasses, spirometry, echocardiography, and serum pro BNP were done for 80 COPD patients and 20 healthy smokers, and some echocardiographic parameters were correlated with degree of airflow limitation. Results 77.5% of COPD cases exhibited pulmonary hypertension (PHTN), and on classifying our COPD patients, it was found that 65% of patients in group II had PHTN and 90% of patients in group III had PHTN. Systolic pulmonary artery pressure (SPAP), mean pulmonary arterial pressure (MPAP), right ventricular mid diameter (RVMD), right ventricular basal diameter (RVBD), right ventricular longitudinal diameter (RVLD), right ventricular outflow tract (RVOT) above pulmonary and aortic valve, and tricuspid annular plane systolic excursion (TAPSE) along with RVEF exhibited a significant variance among all groups. A negative correlation was observed among forced expiratory volume (FEV) 1% and (RVMD as well as RVBD) and between Pro BNP and (TAPSE and RVEF). Conclusions PHTN was found in 77.5% of COPD patients and is negatively correlated with FEV1%. Serum pro BNP level exhibits a negative correlation with FEV1% in stable COPD patients.

Background and Study Aim. Chronic mechanical neck pain significantly impacts the quality of life and functional capacity of individuals, often necessitating long-term management strategies. Traditional stretching exercises are commonly prescribed, but their effectiveness compared to other interventions remains underexplored. The objective of this study was to compare the effectiveness of traditional stretching exercise regimens against thoracic spine and rib mobilization in patients with chronic mechanical neck pain. Material and Methods. This randomized controlled trial included 30 patients aged between thirty and fifty years, all suffering from mechanical neck pain. Patients were randomly assigned to one of two groups, with 15 in each group (Group A: n=15; Group B: n=15). Group A received thoracic spine mobilization coupled with standard passive stretching exercises, whereas Group B underwent a traditional stretching exercise regimen. Both groups were evaluated using the visual analogy scale for pain, active cervical range of motion (ROM), and chest expansion, both before and after a two-week therapy course. Results. Findings from this study were analyzed using a two-way mixed-model multivariate analysis of variance (MANOVA). The results showed no significant differences between Group A (thoracic spine mobilization and standard passive stretching) and Group B (traditional stretching regimen) regarding pain intensity, active cervical range of motion, and chest expansion after the two-week intervention period (p > 0.05). However, significant improvements were observed within each group across all measured outcomes, including reductions in pain intensity and increases in cervical range of motion and chest expansion (p < 0.001). Conclusions. The study confirms that both passive stretching exercises and thoracic spine mobilization are beneficial interventions for enhancing physical outcomes in patients with mechanical nonspecific neck pain. These approaches are equally effective in improving overall physical functionality, underscoring their value in therapeutic settings for neck pain management.

Abstract Background While many denture base materials are currently available on the market, little data exists regarding their dimensional stability after exposure to the oral environment. This study aimed to evaluate the effect of thermocycling on the trueness and precision of milled, 3-dimensional (3D)-printed, and conventional digitally fabricated complete denture bases (CDBs). Methods A completely edentulous maxillary stone model was scanned to generate a standard tessellation language (STL) file; this was imported into metal-milling-machine software (Redon Hybrid CAD-CAM metal milling machine, Redon, Turkey) to produce a metal model for fabricating 30 CDBs. These were divided into three groups (n = 10 in each) according to the construction technique: group 1, CAD-CAM milled CDBs; group 2, 3D-printed CDBs; and group 3, conventional compression molded CDBs. All CDBs were scanned after fabrication and evaluated before and after thermocycling using superimposition. The data were analyzed using a one-way ANOVA, Tukey’s post hoc test, and a paired t-test. Results The level of trueness between the CAD-CAM milled, 3D-printed, and compression molded CDBs showed significant differences before and after thermocycling (P

This study presents a novel approach to integrating combined cooling, heating, and power (CCHP) systems with water desalination for enhanced energy and water management in educational buildings. Two distinct layouts for CCHP and desalination systems are introduced: one prioritizing efficient power generation to meet electricity demands while providing waste heat for desalination, and the other focusing on balancing cooling and heating loads alongside water desalination. Both layouts are tailored to meet the building's energy and water demands while considering operational efficiency. Optimization of these layouts against traditional systems using the bat search algorithm emphasizes economic viability and the gas engine's operational flexibility, which are crucial for partial load operation. In addition, an environmental assessment compares the proposed CCHP-desalination systems with conventional setups, assessing CO2 emission reductions and overall sustainability. The evaluation encompasses key environmental metrics, such as resource consumption and the integration of renewable energy sources. Results highlight significant CO2 emission reductions across various gas engine capacities, with notable enhancements in economic and environmental performance achieved by selecting a 3,250 kW gas engine within the CCHP-desalination system. This choice not only maximizes the annual profit but also reduces CO2 emissions by 57% compared to conventional systems, underscoring the system's sustainability benefits. HIGHLIGHTS This study introduces a novel approach to integrate CCHP systems with water desalination specifically tailored for use in educational buildings.; Two distinct layouts for CCHP and desalination systems are introduced in the article, each tailored to meet the building's energy and water demands while considering operational efficiency.;

Omima Mohammed Ali Omima Mohammed,1 Omaima Abdel Majeed Mohamed Salih,2 Islamia Ibrahim Ahmed Omer,3 Yousra Ibrahim Abdallah Mohammed,4 Omer A Mohammed,4 Ammar Elgadi,4 Lina Hemmeda,4 Walaa Elnaiem,4 Malaz Tarig Abdalla Mohamed,4 Areeba Ahsan,5 Khabab Abbasher Hussien Mohamed Ahmed4 1Department of Pediatrics and Child Health, Mohamed Alamin Hamid Tertiary Pediatric Hospital, Omdurman, Sudan; 2Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Omdurman, Sudan; 3Pediatrics and Child Health Department, College of Medicine, Sulaiman Al Rajhi University, Al-Bukayriyah, Qassim Province, Saudi Arabia; 4Faculty of Medicine, University of Khartoum, Khartoum, Sudan; 5School of Health Sciences, Foundation University, Islamabad, PakistanCorrespondence: Khabab Abbasher Hussien Mohamed Ahmed, Email khabab9722@gmail.comBackground: Asthma is one of the most common non-communicable diseases. Childhood asthma has been increasing in Sudan, with a 13– 16% prevalence among Khartoum school children. To achieve and maintain good asthma control, proper diagnosis, assessment of severity, and appropriate medication administration are crucial, with phenotyping being a key factor in determining patients’ specific treatment.Objective: To study the frequency of severe asthma and the distribution of its different phenotypes and to investigate associations between age and gender and different phenotypes of asthma.Methodology: This descriptive cross-sectional hospital-based study was conducted in the Asthma Clinic of Mohamed Al-Amin Hamid Pediatrics Hospital. It included 229 patients who were presented to the clinic from September 2021 to April 2022. Data were collected from the patients and/or their caregivers using a modified validated standard questionnaire and were analyzed using SPSS version 26.0. A p-value of 0.05 or less was considered statistically significant.Results: In this study of 229 participants, 14.4% had severe asthma, with 44.5% and 41% exhibiting mild and moderate asthma, respectively. Most were effectively managed in steps 2 or 3. The cohort, primarily aged 5 or younger (40.2%) with a male majority (62%), showed a mean diagnosis age of 2.9 ± 2.8 years. Impressively, 90% maintained well-controlled asthma. Within severe asthma cases (87% atopic), 39.4% represented a severe allergic asthma phenotype. Elevated eosinophil counts were noted in 45.5% (serum) and 78.8% (sputum cytology), while 57.6% had normal serum IgE levels. The predominant symptom pattern in severe asthma was episodic multi-trigger wheezing (48.5%). Age and gender displayed no significant association with severe asthma phenotype.Conclusion: This study reveals a concerning rise in childhood asthma prevalence in Sudan, emphasizing the importance of tailored treatment strategies. Severe asthma, characterized by atopic eosinophilic involvement, necessitates targeted interventions in pediatric asthma care for specific phenotypes.Keywords: asthma, pediatrics, respiratory system, chronic obstructive pulmonary diseases, Sudan

Abstract Background Extracorporeal membrane oxygenation (ECMO) has been presented as a potential therapeutic option for patients with cardiogenic shock complicating myocardial infarction (CS-MI). We aimed to investigate the efficacy and safety of ECMO in CS-MI. Methods A systematic review and meta-analysis synthesizing evidence from randomized controlled trials obtained from PubMed, Embase, Cochrane, Scopus, and Web of Science until September 2023. We used the random-effects model to report dichotomous outcomes using risk ratio and continuous outcomes using mean difference with a 95% confidence interval. Finally, we implemented a trial sequential analysis to evaluate the reliability of our results. Results We included four trials with 611 patients. No significant difference was observed between ECMO and standard care groups in 30-day mortality with pooled RR of 0.96 (95% CI: 0.81–1.13, p = 0.60), acute kidney injury (RR: 0.65, 95% CI: 0.41–1.03, p = 0.07), stroke (RR: 1.16, 95% CI: 0.38–3.57, p = 0.80), sepsis (RR: 1.06, 95% CI: 0.77–1.47, p = 0.71), pneumonia (RR: 0.99, 95% CI: 0.58–1.68, p = 0.96), and 30-day reinfarction (RR: 0.95, 95% CI: 0.25–3.60, p = 0.94). However, the ECMO group had higher bleeding events (RR: 2.07, 95% CI: 1.44–2.97, p

Abstract Background Since the onset of the COVID-19 pandemic, multiple studies have reported a bidirectional between COVID-19 and dysfunction of the thyroid gland. These studies have identified various forms of thyroid dysfunction that have been found to affect the severity and outcome of COVID-19 infection. However, the data from these studies have been inconsistent and conflicting. Our objective was to assess the prevalence of various types of thyroid dysfunction among moderate to severe cases of COVID-19 pneumonia. In addition, the study aimed to evaluate the outcome of thyroid dysfunction after recovery from COVID-19 infection. Patient and methods In this observational prospective study data on the clinical features of individuals with moderate to severe COVID-19 pneumonia who were admitted to Zagazig University isolation hospitals from April to December 2022 and their laboratory results were gathered and examined. Thyroid function tests, including TSH, FT3, and FT4, were conducted for all patients upon admission. Follow-up testing was performed on patients who initially had aberrant thyroid lab results 90 days after recovering from COVID-19 infection. Results The study comprised a total of 136 patients who had moderate (44.1%) to severe (55.9%) COVID-19 infection. Sick euthyroid syndrome was the most prevalent form of thyroid dysfunction, accounting for 58.7% of patients with thyroid disorders on admission. After 90 days of post-COVID-19 examination, thyroid dysfunction recovery was observed in 61% of cases. A statistically significant correlation was noted between the severity of COVID-19 and the levels of TSH, free T3, and the ratio of free T3 to T4. A large percentage of patients who showed complete recovery had sick euthyroid syndrome. All patients diagnosed with primary hypothyroidism maintained their hypothyroidism condition, whereas those with hyperthyroidism showed complete recovery. Conclusion COVID-19 patients may experience several patterns of thyroid dysfunction, including nonthyroidal illness syndrome. These dysfunctions are associated with the intensity of the inflammatory response and the severity of the COVID-19 infection. Nevertheless, these alterations are predominantly reversible upon recovery from a COVID-19 infection.

Abstract Live bird markets (LBMs) are considered hotspots for Avian Influenza Viruses (AIVs). In such markets, AIVs pose threats to both poultry and public health. Within LBMs, AIVs spread through various routes, including direct contact, environmental contamination, and aerosol transmission. Unique factors in Egyptian LBMs, such as the coexistence of wild and domestic birds, increase transmission risks between birds as well as spill-overs into exposed humans. Understanding the transmission dynamics of AIVs is vital for implementing effective control measures. We conducted a study in four Egyptian LBMs located in Mediterranean coast cities from November 2021 to March 2023. In this study we tested 3,971 samples from poultry, wild birds, and the environment, out of which 692 (17.4%) were positive for AIV. Poultry exhibited a higher prevalence (42.2%) than wild birds (34.4%). Environmental samples, including water (30.8%), surfaces (17.2%), and air (18.2%), also tested positive for AIV. Diverse AIV subtypes, including H5N1, H9N2, H5/H9 co-infection, and H5N8, were detected among avian species and the environment. Temporal analysis revealed fluctuating IAV positivity rates from November 2021 to March 2023. These results emphasize the importance of continuous surveillance, resource allocation, and multisectoral collaboration to protect poultry and human health, and prevent novel influenza strains’ emergence in Egyptian LBMs.

The present study emphasizes the utilization ability of less expensive industrial waste adsorbents such as fly ash (FA) to adsorb heavy metals from wastewater r to remove its constituent pollutants, amazing eco-friendly technology guarantees benefits with the decrease in the formation of dangerous solid sludge. In the extended experimental work program: parameters such as pH, contact time, and adsorbent dosages were conducted. The results showed a remarkable treatment equilibrium time after two hours. From all the factors, the pH ranges from 5 to 8 significantly influenced the elimination of heavy metals removal efficiencies, and the highest achieved uptake efficiency during the whole three hours of the experiment period was found to be 93%, 90%, 85%, 79 %, 75 % and 70% for Cu, Fe, Ni, Zn, Pb, and Cd respectively with an optimum fly ash treatment dose of 15g/L. Based on several performance metrics and visual indicators, different predictive regression-based models for wastewater heavy metals removal efficiencies were developed and compared to the experimental data. The statistical validation indicators revealed that a high correlation was obtained. In addition, the experiment’s data were utilized using the Langmuir isotherm model. The results of adsorption data were highly satisfactory statistically match providence to Langmuir heavy metals kinetics removal with mean values of 8%, 11%, and 93% for Relative Mean Absolute Error (MAE) rel, Percent Bias (PBIAS), and Nash-Sutcliffe Efficiency (NSE) respectively.

Background and objective: More than 10% of patients with negative clinical metastatic status (cN0M0) on conventional imaging for prostate cancer (PCa) harbor lymph node involvement (pN+) at final pathology following radical prostatectomy (RP) and lymphadenectomy. Our aim was to assess outcomes of initial observation for cN0M0 pN+ PCa and identify prognostic factors that may help in clinical decision-making. Methods: We performed a retrospective multicenter study of patients with cN0M0 PCa on conventional imaging (computed tomography and/or magnetic resonance imaging, and a bone scan) who were found to have pN+ disease at RP between 2000 and 2021. Biochemical recurrence (BCR) and systemic progression/recurrence were the primary outcomes. Kaplan-Meier curves and Cox proportional hazards model were used for survival and multivariate analysis. Key findings and limitations: A total of 469 men were included in this retrospective multicenter trial. Median prostate-specific antigen (PSA) was 10.1 ng/ml (interquartile range [IQR] 6.6–18.0). Among these patients, 56% had grade group ≥4, 53.7% had stage ≥pT3b, 42.6% had positive margins, and 19.6% had PSA persistence. The median number of positive nodes and of nodes removed were 1 (IQR 1–3) and 20 (14–28), respectively. At median follow-up of 41 mo, 48.5% experienced BCR. The 5-yr BCR-free survival rate was 31.7% (95% confidence interval [CI] 26.33–37.1%). Salvage treatments were needed in 211 patients and included radiotherapy (RT; n = 53), RT + androgen deprivation therapy (ADT; n = 88), ADT alone (n = 68), and salvage lymphadenectomy (n = 2). The 5-yr estimated survival rates were 66.3% (95% CI 60.4–72.1) for metastasis-free survival, 97.7% (95% CI 95.5–99.8%) for cancer-specific survival, and 95.3% (95% CI 92.4–98.1%) for overall survival. On multivariable analysis, PSA persistence was an independent predictor of BCR (odds ratio [OR] 51.8, 95% CI 12.2–219.2), exit from observation (OR 8.5, 95% CI 4.4–16.5), and systemic progression (OR 3.0, 95% CI 1.771–4.971). Conclusions: Initial observation in the management of pN+ cN0M0 PCa is feasible and has excellent survival rates in the intermediate term. Patients with worse disease features, especially PSA persistence, have a higher likelihood of recurrence and progression and may be candidates for more aggressive upfront management. Patient summary: We investigated the value of initial observation for men with prostate cancer with negative scan findings for metastasis who were then found to have positive lymph nodes after surgery to remove the prostate. Our results show that initial observation is a good option for patients with less aggressive prostate cancer features.

During the 2022 Nekton Maldives Mission, we deployed a variety of platforms (snorkelling, remotely-operated vehicles and manned submersibles) to conduct video surveys of the biodiversity and composition of shallow (< 30 m), mesophotic (30-150 m) and deep-sea (> 150 m) benthos found in the Maldives’ central and southern atolls. In total, ~ 80 hrs of stereo-video footage were collected during the benthic transect surveys, which were subsequently processed using annotation software in order to evaluate benthic biodiversity and community composition. Here, we present a photographic guide for the visual, in situ identification of reef benthos encountered, including corals, sponges and other invertebrates that inhabit Maldives’ nearshore habitats. We hope that this identification guide will aid future imagery-based surveys or observations of organisms during fieldwork.A total of 283 morphotypes were identified, including those belonging to Octocorallia (61), Scleractinia (57), Porifera (38), Asteroidea (22), Antipatharia (15), Decapoda (13), Hydrozoa (12), Holothuroidea (10), Actiniaria (9), Echinoidea (8), Annelida (6), Chlorophyta (5), Gastropoda (4), Bivalvia (4), Ascidiacea (3), Crinoidea (3), Bryozoa (2), Cyanobacteria (2), Zoantharia (2), Cephalopoda (1), Ceriantharia (1), Corallimorpharia (1), Ctenophora (1), Ophiuroidea (1), Rhodophyta (1) and to an unknown category (1). Out of these, we identified 40 to species level, 120 to genus, 47 to family, 14 to order and suborder, 58 to class and subclass, two to phylum and one was of unknown phylum. This represents the first attempt to catalogue the mesophotic and deep-sea benthic megafaunal diversity in the Maldives using underwater imagery.

Abstract Background Recently, trials have supported changes in deep caries management. However, reporting might lack details, affecting interpretation and implementation. Thus, we aimed to evaluate the adherence to the CONSORT statement and the risk of bias of randomized controlled trials (RCTs) on deep caries management published in pediatric dental journals. Methods We searched PubMed for RCTs in six pediatric dental journals between 2010 and 2022, focusing on deep caries lesion management. Adherence to the CONSORT guideline and the risk of bias were assessed using a modified tool with 19 items; each scored from 0 to 2 (maximum of 38 points), and the Cochrane risk-of-bias (RoB 2) tool. We performed descriptive and regression analyses (α = 5%). Results We analyzed 127 RCTs. The mean (standard deviation) CONSORT adherence score was 21.1 (6.7). Notably, 96.1% of the studies received a score of 2 for the "intervention" item, whereas 83.5% scored 0 for the "estimated effect size”. The risk of bias assessment revealed that 40.2% of the RCTs were at high risk, 59% were at low risk, and 0.8% were at low risk. RCTs with a high risk of bias had lower CONSORT scores (p

Abstract Diabetic nephropathy represents one of the main long-term complications in T2DM patients. Cigarette smoking represents one of modifiable renal risk factors to kidney damage due to lead (Pb) exposure in these patients. Our goal is to investigate serum copeptin and Kidney injury molecule-1 (KIM-1) and urinary lead (UPb) in type 2 diabetes mellitus (T2DM) patients even smokers and non-smokers groups and compared to corresponding health controls and assess its associations with Angiotensin-Converting enzyme Insertion/Deletion polymorphism [ACE (I/D)] polymorphism in diabetic nephropathy progression in those patients. In present study, 106 T2DM patients and 102 healthy control individuals were enrolled. Serum glucose, copeptin, KIM-1, total cholesterol (TChol), triglycerides (TG), estimated glomerular filtration rate (eGFR) and UPb levels and ACE (I/D) polymorphisms were assessed in both groups. Results mentioned to significant variations in all parameters compared to in T2DM group compared to control group. Serum copeptin and UPb demonstrated significant difference in diabetic smokers (DS) and diabetic non-smokers (DNS) groups while KIM-1 exhibited significant change between DNS and healthy control non-smokers (CNS) groups. Positive relation was recorded between serum glucose and KIM-1 while negative one was found between serum copeptin and TChol. D allele was associated with significant variation in most parameters in T2DM, especially insertion/deletion (ID) polymorphism. ROC curve analysis (AUC) for serum copeptin was 0.8, p

Background: Feed additives are products used in poultry nutrition to improve the quality of feed and safety of food byproducts from animal origin. They are promising antibiotic alternatives for production of broilers. Aim: This study aimed to investigate the effect of sodium butyrate (SB) and rosemary leaves (RL) on growth performance, biochemical profile, immunity, and carcass traits of broilers. Methods: Five hundred-one-day old chicks of Hubbard breed were reared on floor pens in a privet farm, Giza. The chicks were weighed on arrival (each chick weighted 43-45 gm) and randomly assigned into five equal groups, with four replicates each (25 chicks/replicate). Group 1 was fed on a broiler diet without any additions (control). The diets of groups 2 and 3 were supplemented with 500 g/ton SB and 4 kg/ton RL, respectively. In group 4, the diet was enriched with 250g/ton SB plus 2 kg/ton RL. Chicks in group 5 were fed on diet fortified with 500 g/ton SB plus 4 kg/ton RL. Results: Supplementation of broiler diet with 500 g/ton SB plus 4 kg /ton RL increased Body weight gain (BWG) and feed efficiency ratio (FER) of birds. It decreased serum levels of aspartate aminotransferase, alanine aminotransferase, total cholesterol triglycerides, malondialdehyde, but increased superoxide dismutase, catalase, and immunoglobulins, phagocytic activity, lysozyme activity, and nitric oxide concentrations. Antibody titers against Newcastle disease virus were also elevated. Conclusion: Supplementation of broiler diet with 500 g/ton SB plus 4 kg/ton RL gives the best result regarding productive efficiency and immunity of broiler chickens. [Open Vet J 2024; 14(5.000): 1243-1250]

Introduction: The aluminum and vanadium contents of the titanium-aluminum-vanadium alloy (Ti-6Al-4V) surface are known to have cytotoxic effect, the use of laser grooving was thought to produce dental implants-controlled surface roughness and a better surface chemical composition. Aims: The aim of the current work was to test the titanium alloy machined and laser grooves surface content of the aluminum and vanadium, and their effect on cellular viability. Materials and Methods: Threaded titanium dental implants were designed, milled and micro-grooved using the Avia coherent pulsed ultraviolet laser and produced 10 µm grooves on their machined surface. The scanning electron microscope was used to evaluate the produced micro-grooves, and the X-ray diffraction to study the surface composition of the titanium alloy before and after laser grooving. And the MC3T3-E1 mouse osteoblasts were cultured on such surfaces to test their cytotoxic effect. Results and Discussion: The laser grooving significantly reduced the alloy surface content of the aluminum and vanadium as proved by the significantly better viability of the cells cultured on it as compared to the machined surface. Conclusion: The laser grooving reduced the Ti-6Al-4V alloy surface content of the cytotoxic elements.

Abstract Background Although the efficacy and safety of epidural block (EB) are fairly high, complications such as inadvertent dural puncture may limit its use. Ultrasound-guided quadratus lumborum block (QLB) is a relatively new regional technique that provides perioperative somatic and visceral analgesia for pediatric patients. This trial compared the quality of pain relief in pediatric patients undergoing abdominal surgery who received either QLB or EB. Methods Patients were randomly allocated into two equal groups: Group E(n = 29): received EB; Group QL(n = 29): received QLB. Both groups were injected with 0.25% bupivacaine (0.5 ml/kg). Assessment of total analgesia consumption was the primary outcome measure, whereas the secondary outcome measures were assessment of postoperative analgesic effect by Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) and time of first analgesic request. Results Our study showed that the mean total fentanyl consumption was comparable between both groups(38.67 ± 5.02 and 36.47 ± 5.13 µg in the E and QL groups, respectively, P = 0.246). Only five patients did not require rescue analgesia (3 in the E group,2 in the QL group, P = 0.378). The mean duration of analgesia showed no significant difference between the two groups (9.9 ± 1.58 and 11.02 ± 1.74 h in the E and QL groups, respectively, P = 0.212). Evaluation of CHEOPS score values immediately in PACU and for the initial 24 h following operation showed no significant difference between the two study groups(P > 0.05). Conclusion QLB can achieve analgesic effects comparable to those of EB as a crucial part of multimodal analgesia in children undergoing abdominal surgeries. Clinical trial registration number PACTR202203906027106.

Abstract Background Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive non-Hodgkin lymphoma (NHL), constituting 31% of all NHL. Malignancy and inflammation are closely linked. Inflammatory processes have been identified to play an important role in the pathogenesis of lymphoma. Obesity is a well-known risk factor not only for the development of cardiovascular disease and diabetes but also for the development of several types of cancer, including lymphomas. Objective To find out the association of pan-immune-inflammation value (PIV) and body mass index (BMI) with survival in adults with diffuse large B-cell lymphoma. Patients and methods We conducted an observational retrospective study on 110 patients to unravel the association of PIV and BMI with survival outcome in a cohort of adults diagnosed as de novo DLBCL (NOS) and treated at the hematology units of International Medical Center, Helwan and Menoufia University Hospitals, in the period from 2014 to 2018. Results The mean age of the studied patients was 54.27 years, the mean BMI was 28.91, and the median and IQR for PIV were 195.84 (96.20–498.52). The cutoff value for detecting mortality in BMI was 29.74 kg/m2 with poor sensitivity (44.4%) and poor specificity (67.2%). The cutoff value for detecting mortality in PIV was 250.49 with poor sensitivity (50.0%) and poor specificity (67.2%). The mean duration of overall survival was 21.596 months. There was nonsignificant difference regarding 2-year overall survival according to BMI grouping (p-value = 0.195) and PIV grouping (p-value = 0.275). Conclusion Neither PIV nor BMI were associated with 2-year overall survival in patients with DLBCL.

Abstract Background Measurement of the circulating levels of long-non-coding RNAs (lncRNAs) in lupus nephritis (LN) patients could dramatically explore more insights about the disease pathogenesis. Hence, we aimed to quantify the level of expression of CTC-471J1.2 and NeST in LN patients and to correlate it with the disease activity. Method This case-control study was conducted on a group of children with juvenile LN attending to Mansoura University Children’s Hospital (MUCH). Demographics, clinical, and laboratory findings were collected besides the measurement of lncRNAs by quantitative real-time PCR. Results The expression level of lncRNAs-CTC-471J1.2 was significantly down-regulated in children with active LN versus inactive cases or controls. In contrast, the NeST was significantly up-regulated in active LN cases. A significant correlation was found between CTC-471J1.2 expression and LN activity parameters. Additionally, both lncRNAs showed a reasonable sensitivity and specificity in differentiation of active LN. A regression analysis model revealed that CTC-471J1.2 and NeST were independent predictors of active nephritis. Conclusion The expression level of circulatory lncRNAs-CTC-471J1.2 and NeST can be used as sensitive and specific biomarkers for active LN. Furthermore, both could serve as predictors for nephritis activity.

Abstract The emergence of microgrids arises from the growing integration of Renewable Energy Resources (RES) and Energy Storage Systems (ESSs) into Distribution Networks (DNs). Effective integration, coordination, and control of Multiple Microgrids (MMGs) whereas navigating the complexities of energy transition within this context poses a significant challenge. The dynamic operation of MMGs is a challenge faced by the traditional distributed hierarchical control techniques. The application of Artificial Intelligence (AI) techniques is a promising way to improve the control and dynamic operation of MMGs in future smart DNs. In this paper, an innovative hybrid optimization technique that originates from Cheetah Optimization (CHO) and Particle Swarm Optimization (PSO) techniques is proposed, known as HYCHOPSO. Extensive benchmark testing validates HYCHOPSO’s superiority over CHO and PSO in terms of convergence performance. The objective for this hybridization stems from the complementary strengths of CHO and PSO. CHO demonstrates rapid convergence in local search spaces, while PSO excels in global exploration. By combining these techniques, the aim is to leverage their respective advantages and enhance the algorithm's overall performance in addressing complex optimization problems. The contribution of this paper offering a unique approach to addressing optimization challenges in microgrid systems. Through a comprehensive comparative study, HYCHOPSO is evaluated against various metaheuristic optimization approaches, demonstrating superior performance, particularly in optimizing the design parameters of Proportional-Integral (PI) controllers for hierarchical control systems within microgrids. This contribution expands the repertoire of available optimization methodologies and offers practical solutions to critical challenges in microgrid optimization, enhancing the efficiency, reliability, and sustainability of microgrid operations. HYCHOPSO achieves its optimal score within fewer than 50 iterations, unlike CHO, GWO, PSO, Hybrid-GWO-PSO, and SSIA-PSO, which stabilize after around 200 iterations. Across various benchmark functions, HYCHOPSO consistently demonstrates the lowest mean values, attains scores closer to the optimal values of the benchmark functions, underscoring its robust convergence capabilities.the proposed HYCHOPSO algorithm, paired with a PI controller for distributed hierarchical control, minimizes errors and enhances system reliability during dynamic MMG operations. Using HYCHOPSO framework, an accurate power sharing, voltage/frequency stability, seamless grid-to-island transition, and smooth resynchronization are achieved. This enhances the real application's reliability, flexibility, scalability and robustness.

Background: Endoscopic ultrasound-guided biliary drainage is widely accepted due to its high success rate, minimal need for re-intervention, and low incidence of pancreatitis. Our objective was to investigate the feasibility, efficacy, and outcomes of primary EUS-guided choledochoduodenostomy (EUS-CDS) compared to endoscopic retrograde cholangiopancreatography (ERCP) in patients with malignant distal biliary obstruction (MDBO). Methods: In this prospective multicenter study conducted between May 2021 and April 2023, patients with unresectable MDBO were assigned to either EUS-CDS or ERCP. Technical and clinical success were the primary endpoints. Results: A total of 73 patients at three tertiary centers were enrolled, of whom 37 underwent EUS-CDS and 36 underwent ERCP. Pancreatic cancer was present in 62 patients (84.9%). The technical and clinical success rates were comparable (97.3% and 97.2% for EUS-CDS vs. 94.4% and 100% for ERCP, respectively), with nearly the same procedure duration (P = 0.982) and with no significant difference in adverse events between both groups. Pancreatitis occurred in one patient after ERCP. Short-term re-intervention (within 3 months) was only required in two patients in the EUS-CDS group. Conclusion: Primary EUS-CDS—even in developing countries—is feasible, with comparable safety and non-inferior efficacy to ERCP for palliation in MDBO cases if a highly experienced team is present.

Introduction: Single-implant Overdentures (1IODs) have gained popularity as a more economical protocol than Two-implant Overdentures (2IODs). However, concerns have existed about the longevity of using a single implant compared to two implants. Aim: To investigate the marginal bone loss and stress distribution around dental implants assisting 1IODs compared to 2IODs within five years of clinical service. Materials and Methods: This randomised clinical trial was conducted at the Department of Prosthetic Dental Sciences, College of Dentistry of Qassim University in the Kingdom of Saudi Arabia from June 2018 to September 2023. Total 40 completely edentulous male patients, aged 50 to 60 years, were blindly allocated to two groups. Group I included 20 patients who received two implants at the canines’ regions, and Group II included 20 patients who received one implant under their mandibular overdentures at the midline of the mandible. The implants in both groups were followed up immediately after loading, at six and 12 months, three years, and five years for probing depth, mobility, and vertical bone loss. Finite Element Analysis (FEA) was used for stress analysis around the implants. One-way Analysis of Variance (ANOVA) and Mann-Whitney tests were used for statistical analysis at a significance level of p

Abstract Background & aims Eosinophilic ascites is non-common and challenging disease. This study aimed to describe the clinical presentation and treatment of eosinophilic ascites. Methods This was a prospective single-center study that included cases with eosinophilic ascites who were admitted to Tropical Medicine and Gastroenterology Department, Assiut University Hospital, Assiut, Egypt, during the period between May 2020 to May 2023. The clinical presentation, investigations, treatment, and follow-up data of the included patients were collected and analyzed. Results Seventeen cases of eosinophilic ascites were included in the study. The main presenting manifestations were abdominal pain (47.1%), and abdominal pain with distension (29.4%). Two patients presented with a picture of intestinal obstruction. Moderate ascites was found in 10 patients (58.8%) by ultrasound. Eosinophilia in the peripheral hemogram was detected in 76.5% of the study population. Endoscopic examination showed gastro-duodenitis in 9 patients (52.9%) and duodenitis in 4 patients (23.5%). All patients showed complete improvement and disappearance of ascites after starting steroids within two weeks. Eleven patients (64.7%) relapsed after discontinuation of steroids. Conclusion Eosinophilic ascites is an uncommon cause of ascites that is often underdiagnosed. The relapse rate after stopping treatment is high but with excellent response to retreatment.

Iman Bashir Hamid Abashar,1,&ast; Omaima Abdel Majeed Mohamed Salih,2,&ast; Tarteel Abbas Abaker Joda,3,&ast; Mai Fathi Awadalla Alsedig,3,&ast; Alaa T Omer,3,&ast; Hayat A Ahmed,3,&ast; Lina Hemmeda,3,&ast; Mariam Alazraa M Esmaeel,3,&ast; Khabab Abbasher Hussien Mohamed Ahmed3,&ast; 1Asthma Clinic Mohammed Alamin Hamid Pediatric Hospital, Omdurman, Sudan; 2Departments of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Omdurman, Sudan; 3Faculty of Medicine, University of Khartoum, Khartoum, Sudan&ast;These authors contributed equally to this workCorrespondence: Mariam Alazraa M Esmaeel, Faculty of Medicine, University of Khartoum, ElQasr Avenue, Khartoum, Khartoum State, 11111, Sudan, Tel +249915077027, Email mariamrashad17@gmail.comBackground and Aims: It is essential to have proper treatment and management for asthma in order to minimise symptoms, lessen the burden, and lower the chance of exacerbations. To better control asthma, the purpose of this study was to evaluate and enhance paediatric registrars’ understanding and application of asthma treatment.Methods: The Sudan Medical Specialisation Board (SMSB) paediatric registrars provided data for this quasi-interventional study between April and September of 2021. Twice, both before to and following the intervention education sessions, the questionnaire was delivered. SPSS version 28 was used to analyse the data after it had been cleaned up in an Excel document.Results: 203 (or 77.8%) of the 261 were women. A substantial rise from 8.1 ± 4.12 SD to 18 ± 5.03 SD in the mean overall knowledge score of registrars between the pre-and post-intervention periods. A significant difference (p=0.001) was observed in the post-intervention phase, with first-year registrars (R1) demonstrating higher scores than their senior colleagues. The registrars’ total knowledge scores did not differ significantly from one another during the pre-intervention period. The Global Initiative of Asthma (GINA) guidelines of management were implemented to a certain extent, according to the study. Of the registrars, 148 (56.7%) and 203 (77.8%) evaluated step one management in children ages 5 and under; 66 (25.3%) and 213 (81.6%) evaluated step one management in children ages 6 to 11; and 66 (25.3%) and 213 (81.6%) evaluated step one management in children ages 6 to 11 in pre- and post-intervention, respectively.Conclusion: Given that the intervention in this study greatly increased registrars’ knowledge, doctors should obtain training on the GINA 2019 recommendations through conferences, workshops, and academic programmes. To find out why R1 outperforms their older counterparts, more investigation has to be done.Keywords: asthma, GINA, management of asthma, Sudan

As societies are shifting toward carbon neutral environments, they are beginning to account for their carbon emissions. One of the primary contributors of greenhouse gas emissions and global warming is the building industry; therefore, Life Cycle Assessment (LCA) is one of the instruments that allows an assessment of the energy and the energy-related environmental impacts of the buildings from cradle to grave, according to ISO 14040. In this context, the aim of this research study is to assess the Life Cycle carbon dioxide (LC CO2eq) emissions over a 50-year-lifespan of a zero-carbon solar-powered earth-based building, built with carbon-free adobe bricks, in the hot semi-arid climate of Morocco. While research on the carbon dioxide equivalent (CO2eq) emissions across the life cycle is crucial to determine the energy-intensive stages, this study looks into global tendencies of CO2eq emissions arising during the cradle-to-gate embodied (A1-3) and operational (B6) phases of a Zero Carbon Building (ZCB) case study, and which should be offset by carbon-free energy in order to abide by the ZCB definition. Results show that the LC CO2eq emissions of the eco-friendly zero-carbon residential building falls in 48.62 Kg CO2eq/m2.y., with an operational phase that has a share of around 93 % of global LC CO2eq emissions. In addition, when conventional construction materials such as concrete, bricks, and insulation materials are used as an alternative, embodied carbon emissions accounts for 6.3 kg CO2eq/m2.y. and is 85 % higher than the eco-friendly building, and it constitutes approximately 12.5 % of the overall carbon footprint. Moreover, the annual embodied and operational CO2eq emissions are offset by the 3.3-kWc-building-added-photovoltaic system. Hence, the conducted case study offers valuable insight into the good practices for decarbonization of Morocco's building stock.Through that case study, we aim to generate knowledge of net zero carbon buildings within the African continent, promoting the perks of decentralized solar energy in leaping forward a carbon-free electrified continent and valorizing the local construction techniques and knowhow in the building sector.

Turbulent and non-turbulent analysis of thermomagnetic convection, heating rate and mass transport of Darcian radiating nanofluid flow through porous slanted sheet is the aim of present study. Influence of microgravity is more useful for the movement of thermophoresis nanoparticles with maximum temperature and density. Joule heating, porous medium, magnetic field and thermal radiations are incorporated for the performance of thermal convection. Governing equations are reduced in dimensionless form. Oscillatory stokes conditions are applied to separate the steady, real and imaginary equations. Finite difference, Primitive transformation, and Gaussian elimination techniques are applied for numerical outputs. For asymptotic results, the appropriate range of parameters such as 0.1≤JH≤15.0, 0.1≤Pr≤12.0, 0.1≤Rd≤25.0, 0.0≤λT≤5.0, 0.1≤NT≤1.0, 0.1≤Fr≥6.0, and 0.1≤δ≤1.0 is utilized. Main novelty of work is to examine the steady state and oscillatory behavior of friction-rate, heat/mass transport over slanted two-angles π/6 and π/4. Maximum amplitude in fluid velocity is observed by increasing radiations and buoyant forces. Temperature distribution and nanomaterial concentrations enhance as Joule-heating and Prandtl number increases under microgravity region. Amplitude and oscillation of heat and mass rate is increased as reaction rate, Joule heating and Forchheimer parameter increases. Enhancing behavior of energy transport is observed for maximum choice of Prandtl index with small magnetic effects. It is depicted that high rate of oscillating frequency in heat transmission is detected with maximum radiation effects.

The influence of thermal radiations and Soret/Dufour significantly increases the mass and heat transport in material science, geothermal process, chemical rectors and heat exchangers due to temperature and concentration variation of nanoparticles. Main objective is to enhance the amplitude, oscillation and frequency of heat transfer using the Soret and Dufour characteristics in Darcian radiating flow of thermophoretic nanoparticles along vertical porous surface. The dimensionless analysis is performed to develop the convenient form of governing thermodynamic Darcian nanofluid formulation. To develop the programming algorithm in FORTRAN language, the primitive variable formulation is used for both time-dependent and steady models. The numerical and graphical outcomes of primitive type equations under boundary conditions are explored by using implicit finite difference approach with Gaussian elimination scheme. Various pertinent parameters are used to elaborate the steady fluid velocity, surface temperature and steady concentrated nanoparticle volume fraction. Valuable novelty of current research is to use steady results for fluctuating shear stress, fluctuation heating rate and fluctuating mass rate. It is found that the influence of Soret and Dufour parameter enhances the fluid velocity and temperature distribution with maximum variations. It is noticed that the temperature distribution enhances as thermal radiation parameter increases. The oscillation and transient stability of heating rate enhances with prominent variations as thermal radiation and Soret/Dufour parameter increases. It is depicted that amplitude in shear stress and mass rate enhances as Soret and Dufour parameter enhances.

Purpose Technical differences may explain why elite hurdles specialists (EHS) and elite decathletes (ED) perform differently in the 110-metre hurdles. This study aims to compare the hurdle-unit kinematic parameters in EHS and ED. Methods A total of 20 male athletes were recruited, including 10 EHS (age: 20.9 ± 2.2 years, body mass: 76.9 ± 7.0 kg, height: 1.85 ± 0.05 m) and 10 ED (age: 20.8 ± 2.27 years, body mass: 87.7 ± 6.9 kg, height: 1.91 ± 0.03 m). Their three-dimensional movement was analysed for hurdling sequences over the whole hurdle-crossing phase and the entire cycle of the first stride after the hurdle, with spatial, temporal, and angular characteristics compared between groups. Results EHS were characterised by faster hurdle crossing (p = 0.002), shorter stride length over the hurdle (p = 0.002), and a shorter support phase in the first stride post-hurdle (p = 0.005). The centre of mass (CM) path of ED was higher than that of EHS (p = 0.003). EHS attack the hurdle with the lead leg’s knee significantly more flexed (p = 0.001) and after crossing the hurdle, regain contact with the ground with the lead leg more flexed at the hip level (p = 0.004), the trunk more inclined forward (p = 0.01), and a relatively smaller positioning angle of the supporting leg (p = 0.021). Conclusions EHS can be identified by their reduced impulse time, abbreviated take-off phase over the hurdle, and accelerated landing. Furthermore, EHS achieved optimum speed between obstacles faster, resulting in less speed loss and enhanced performance.

Abstract Background Left ventricular hypertrophy (LVH) is associated with an increased risk of ventricular arrhythmias and cardiovascular mortality. The study objective was to investigate the effect of LVH severity on the complexity and severity of ventricular arrhythmias among a subset of Egyptian hypertensive patients. Results The study cohort consisted of 60 hypertensive patients with LVH as diagnosed by echocardiography. Their mean age was (53.7 ± 12.3) years. 36 males (40%) and 24 females (60%). Diabetes mellitus was found in 26 patients (43%), 41% of these cases were smokers. 48-h Holter monitoring was performed in all cases to assess the frequency of ventricular premature contractions (VPC) and their complexity using the Lown grading. Increasing posterior wall thickness end diastole (PWTd) was an independent predictor of increasing VPC frequency, each 1 mm increase in the PWTd is associated with a 1.26% increase in the VPC% among total heart beats (b = 12.6, p

Nine Magnetotelluric stations and 198 Land-Magnetic points were conducted within reclamation regions at the western and southwestern areas of the New Sphinx City, Egypt. The main target is to explore the deep groundwater aquifer (Nubian Aquifer), and its reserves. This was interpreted with integrated data available from thirteen water wells within the studied area. Their depths range from 160 to 773 m. We noticed that the wells don’t reach the Nubian Aquifer and the groundwater in the area comes from the Jurassic-Lower Cretaceous, the Upper Cretaceous-Eocene Limestone, and the Oligo-Miocene aquifers, which contain brackish/saline water. The groundwater table ranges between 128-170 m from the topographic-controlled ground surface. Structurally, the area is dissected by two major thrust faults trending in the NE-SW direction, while there is one major normal fault trending in the NW-SE direction. The results showed that the basement relief ranges between -2250 to -4650 m below mean sea level. The Nubian Aquifer extends through the central region within the area according to the results of Nine Magnetotelluric data. It is bounded by the two inverted faults within the Kattaniya inverted basin which is gradually thinning in the southward direction to disappear completely at the Gindi basin. It is partitioned into two units; the upper one was found at an average depth range between -1760 to -2245 m with an average thickness of about 485 m, while the lower unit depth ranges between -2800 to -3825 m with an average thickness of about 1025 m.

Background and Aim: Cardiovascular imaging plays an essential role in the early detection of cardiac injury and left ventricular (LV) function subclinical alterations. Non-invasively, speckle-tracking imaging provides objective and quantitative assessment of global and regional cardiac function. We investigated whether speckle tracking echocardiography (STE) can be used to distinguish between ischemic cardiomyopathy (ICM) and non-ischemic dilated cardiomyopathy (NICM) based on the pattern of cardiac deformation. Materials and Methods: This research involved cases of dilated cardiomyopathy during the period from January 2022 to December 2022 in 100 patients separated into two groups. Baseline clinical data were evaluated. Conventional and STE were done. The cases were separated into two groups: Group A involved 50 cases with a history of ischemia confirmed by coronary angiography and group B involved 50 cases with NICM who had normal coronary angiography. Results: Patients with NICM had significantly greater LV volumes, lower LV systolic function, and lower global longitudinal and circumferential strain. Basal longitudinal strain over the sum of mid and apical longitudinal strain was significantly lower in NICM (0.42 ± 0.03 vs. 0.49 ± 0.03, P < 0.001). Moreover, regional longitudinal strain decreased from apical to basal in NICM and was homogeneous throughout all segments in ICM. Conclusion: Two-dimensional-STE can help differentiate ICM from NICM. Patients with NICM had a specific strain pattern as basal worsening of LV systolic strain with relative apical sparing.

Salinity is one of the most important abiotic stresses that significantly decreases the productivity of agricultural crops. Melatonin (MT) acts as an antioxidant and plays a vital role in overcoming oxidative damage. However, previous literature has not provided a clear understanding of the impact of MT on lettuce plants under salinity stress. So, we investigated the effect of exogenous MT at 0 μM, 50 μM, 100 μM and 150 μM on lettuce plants grown under salinity stress (0 mM NaCl, 50 mM NaCl and 100 mM NaCl) with respect to vegetative growth, photosynthetic pigments, relative water content (RWC), electrolyte leakage (EL), malondialdehyde (MDA), H2O2, O2•- and antioxidants enzymes. Results showed that NaCl stress significantly decreased vegetative growth, RWC and photosynthetic pigments and in contrast enhanced dry matter, EL, MDA, H2O2, O2•-, Na+, Cl-, peroxidase (POD), superoxide dismutase (SOD) and glutathione reductase (GR) of lettuce plants compared to non-salinized control. The results demonstrated that under salinity conditions, foliar applications of MT significantly alleviated the harmful effects of salinity and increased number of leaves, leaf area, fresh weight, chlorophyll (a), chlorophyll (b), total chlorophyll, carotenoids and RWC in comparison to untreated plants (control). Meanwhile, dry matter, MDA, H2O2, O2•-, Na+, Cl-, POD, SOD and GR were significantly decreased compared to untreated lettuce plants. In this respect, spraying MT at 150 μM ranked the first, then 100 μM, compared to the lower concentration (50 μM). In conclusion, MT application can be used to alleviate harmful effects of salinity stress.

Abstract Background Regional anesthesia is the favored choice in ruminant animals compared to general anesthesia, primarily due to its high safety margin and reduced demand for cost-intensive equipment in addition to its field applicability. Ultrasound-guided nerve block has gained significant attention in the field of veterinary medicine. This study utilized twenty-seven sheep of the native Rahmani breed to both demonstrate and evaluate the effectiveness of the ultrasound guided inferior alveolar nerve block technique. Methods The research comprised three phases: Phase 1 involved an anatomical examination of mandibles and sheep heads to locate the mandibular foramen and delineate the mandibular nerve course. Phase 2 included ultrasound-guided injection of methylene blue dye at specific sites along the mandibular nerve in cadaveric sheep heads. In Phase 3, clinical implementation of ultrasound-guided inferior alveolar nerve blocks was conducted in 27 live sheep, assessing efficacy, onset, and duration. Results Vertical extraoral ultrasound-guided nerve block was achieved successfully in 25 sheep (98%). A preliminary cadaveric study showed good distribution of the injectate at the mandibular nerve site. The mean onset time was 138 ± 18 s, and the mean duration time was 54 ± 4.1 min. Prominent analgesia of the ipsilateral mandible, medial surface of the cheek, and lateral border of the tongue was observed. Conclusions Ultrasound-guided mandibular nerve block holds promise as a technique for providing effective and safe anesthesia in sheep undergoing mandibular procedures.

Background: Anal fistula, which causes periodic swelling and pain in the perianal area followed by spontaneous leakage, is an abnormal connection between the anal canal and the perianal skin. The majority are connected to the development of abscesses, with a perianal fistula existing at the time of presentation in one-third of patients with an anorectal abscess. Objectives: to determine the safety and efficacy of the Ligation of Intersphicteric Fistulous Tract operation (LIFT) in comparison with fistulotomy. Patients and methods: On 60 patients with low trans-sphincteric perianal fistulas, this prospective, randomized comparative research was done at the General Surgery Department of Qena Faculty of Medicine. Patients were split into two groups: Group (A): 30 patients underwent LIFT techniques. Group (B): 30 patients underwent fistulotomy. The duration of the study ranged between 6-12 months, Results: Body Mass Index (BMI) was statistically substantial greater in patients treated by LIFT than those treated by fistulotomy. While pain score and healing time were statistically substantial lower in patients treated by LIFT than those treated by fistulotomy. There is no statistically substantial variation between patients treated by fistulotomy and LIFT as regard the development of complications as recurrence or incontinence. Conclusion: In comparison to open fistulotomy, the LIFT operation is a successful and preferred sphincter-saving method for fistula-in-ano, with a quicker healing period and a decreased frequency of postoperative anal leakage.

This work addresses the important issue of frequency stability in shipboard microgrids (SMGs), which are confronted with difficulties because of the alternating power insertion from green sources and low system inertia. In order to sustain a consistent frequency (despite system uncertainties), a study and precisely calibrated regulator is necessary. Therefore, this article proposed a new combined three degree of freedom proportional integral derivative (3DOF-PID) and tilted-integral (TI) regulators for achieving enhanced system performance, robustness, and enhance the frequency performance of a power grid. The superior performance of the suggested 3DOF-PID-TI has been assured by comparing it with three distinct controller architectures (FOPID, PDPID2 and 2DOF-PID) for the multi-energy SMG system. The investigation also took into account the temporal delays brought on by the communication links between the sensor and the regulator. The triangulation topology aggregation optimizer (TTAO), a relatively new meta-heuristic technique that hasn’t been employed to load frequency control (LFC) issues until recently, was employed to adjust the controllers’ parameters. The TTAO’s frequency performance outcomes were thoroughly contrasted to those of other optimization algorithms (i.e., Chimp, Whale, and Gradient-Based Optimization Algorithms) so as to evaluate the optimization efficacy of the suggested optimizer. The findings showed that the proposed 3DOF-PID-TI controller, whose parameters has been tuned by TTAO, outperformed its competitors in terms of overshoot (15.87mHz), undershoot (-29.04mHz), settling time (2.49sec) and performance index (i.e., ITAE(0.0171)). Additionally, the suggested controller’s robustness was assessed in a range of SMG operating situations as ex. (Random Multi-Step Variation in Load, Real Data on Stochastic Power Fluctuations, Energy Storage System Impact on the system and sensitivity analysis). The acquired data amply proved that when crucial system parameters experience a substantial variation, the controller’s gains set under normal circumstances do not need to be re-tuned.

Background: Bezoars are indigestible lumps which are usually found in stomach. Types of bezoar include phytobezoar, trichobezoar, lithobezoar, pharmacobezoar, plasticobezoar, lactobezoar and metal bezoar. Trichobezoars mostly affect females in 20s and 30s with a rarity in paediatrics. Unexplained complaints with a palpable mass are commonly found in these patients. Treatment involves retrieval of mass with searching for others. The purpose of this study was to present data and surgical management of cases with trichobezoars. Materials and Methods: We documented a retrospective review of trichobezoars done in our hospital between 2016 and 2022. All demographic data collected included gender and age of cases, composition and extent of bezoar, clinical presentation, imaging modalities, endoscopic trial, surgical approach and outcome. Results: Five cases of gastrointestinal tract (GIT) trichobezoars underwent surgery. All cases were females between (13 and 16 years). Trichobezoars were three gastric, one ileal and one of combined gastric and colonic. Complaints were abdominal pain, vomiting, weight loss and halitosis. Three cases had a palpable abdominal mass. Different radiological modalities were performed. Endoscopic retrieval was tried in one patient and the laparoscopic approach in another one, but the first route failed. Laparotomy followed by gastrotomy, enterotomy and colotomy was done without complications. Conclusions: Trichobezoars should be suspected in any child with unexplained abdominal complaints or with a palpable abdominal mass, especially in girls. Imaging can be done in different modalities for diagnosis. Endoscopic retrieval could be tried; however, its failure is common, necessitating laparotomy, which has an excellent outcome.

Background: Hepatocellular carcinoma (HCC) is the third leading cause of cancer death worldwide. The 5-year survival rate for liver cancer in the US has improved from 3% four decades ago to 20% now. Transarterial chemoembolization (TACE) is the treatment of choice for stage B/intermediate-stage HCC. Complications of TACE include hepatic encephalopathy, liver failure, post-embolization syndrome, duodenal ulcers, liver abscesses, acute cholecystitis, and injury to the biliary tract. This study evaluates the 30-day readmission rate and predictors of readmission among patients with HCC undergoing TACE. Methods: The 2016–2018 Healthcare Cost and Utilization Project (HCUP) database, which includes the National Readmission Database (NRD), was used. All adult patients with HCC who underwent TACE were identified using the International Classification of Diseases (ICD-10). The rate of 30-day readmissions after TACE and the associated diagnoses were identified. Logistic regression was used to obtain adjusted odds ratios for variables associated with 30-day readmission. Results: A total of 566 patients underwent TACE between 2016–2018. Sixty-five patients were excluded due to death and unavailability of 30-day readmission data. The procedure was performed in large (80.4%), metro-teaching hospitals (94.5%). Mean patient age was 65.1 ± 9.9 years, and 74% of patients were male. Among the 501 patients, 81 (16.2%) were readmitted within 30 days. The mean age for readmitted patients was 63.2 ± 11.0 and 69.1% were male. The mean length of stay at readmission was 5.5 ± 7.3 days. A total of 7.4% of patients had neurological disorders, 17.3% had weight loss, 30.9% had fluid and electrolyte imbalance, and 21.0% had hepatic encephalopathy. The most common primary diagnoses at 30-day readmission were liver cell carcinoma, sepsis, and liver failure. Univariate analysis for variables associated with 30-day readmission included hepatic encephalopathy (OR 3.45; 95% CI 1.8–6.62; p = 0.0002), underlying neurological disorders (OR 3.28; 95% CI 1.16–9.3; p = 0.03), weight loss (OR 2.82; 95% CI 1.42–5.61; p = 0.003), and Medicaid status (OR 1.74; 95% CI 1.05–2.88; p = 0.03). Multivariable analysis showed hepatic encephalopathy (OR 2.91; 95% CI 1.4, 6.04; p = 0.04) and weight loss (OR 2.37; 95% CI 1.13–4.96; p = 0.02) were associated with hospital readmission. Conclusions: Weight loss and hepatic encephalopathy were predictors for 30-day readmission after a TACE procedure for HCC.

Subsidence, the downward vertical land motion (VLM), plays a pivotal role in contributing to the risk of coastal flooding. Accurately estimating VLM and identifying its potential features related to subsidence can provide crucial information for stakeholders to make better-informed decisions. This study aimed to estimate large-scale subsidence at the Texas Gulf Coast and identify potential subsidence features using explainable models. Nine potential features were considered for modeling the VLM, ranging from natural terrain variations to anthropogenic activities. These features were used to train a random forest (RF) machine learning model. Explainable artificial intelligence (XAI) techniques including SHapley Additive exPlanations (SHAP) and impurity- and permutation-based feature importance were used to identify the contributions to subsidence. The results demonstrated favorable performance of the RF model, achieving an $R^{2}$ value of 0.56 during validation. XAI results underscored the significance of the digital elevation model in explaining subsidence at the Texas Coast. Additionally, XAI analysis highlighted the overall contribution of subsidence from anthropogenic activities, such as hydrocarbon extraction and groundwater withdrawal. Furthermore, the sample-level SHAP map provided detailed and reasonable subsidence-attribution results across the study area, showing potential for automatic and data-driven explanations of the VLM.

An accurate rainfall–runoff observation is critical for giving a warning of a potential damage early enough to allow appropriate response to the disaster. The long short-term memory (LSTM)-based rainfall–runoff model has been proven to be effective in runoff prediction. Previous research has typically utilized multiple information sources as the LSTM training data. However, when there are many sequences of input data, the LSTM cannot get nonlinear valid information between consecutive data. In this paper, a novel informer neural network using empirical wavelet transform (EWT) was first proposed to predict the runoff based only on the single rainfall data. The use of EWT reduced the non-linearity and non-stationarity of runoff data, which increased the accuracy of prediction results. In addition, the model introduced the Fractal theory to divide the rainfall and runoff into three parts, by which the interference caused by excessive data fluctuations could be eliminated. Using 15-year precipitation from the GPM satellite and runoff from the USGS, the model performance was tested. The results show that the EWT_Informer model outperforms the LSTM-based models for runoff prediction. The PCC and training time in EWT_Informer were 0.937, 0.868, and 1 min 3.56 s, respectively, while those provided by the LSTM-based model were 0.854, 0.731, and 4 min 25.9 s, respectively. HIGHLIGHTS The informer network was innovatively introduced into rainfall–runoff prediction, which reduced time and spatial complexity.; The empirical wavelet transform was utilized to enhance the treatment of non-linearity and non-stationarity.; Fractal theory was applied to eliminate the interference caused by excessive data fluctuations.;

Purpose – This paper aims to address three research questions (1) Who is the main stakeholder that shapes Airbnb experience, (2) Does Airbnb offers an authentic travel experience? and (3) What should be the future research trends in Airbnb? Design/methodology/approach – This paper uses the systematic literature review (SLR) with a well-defined protocol, research strategy and methods to answer the research questions. Findings – The review revealed that while Airbnb plays a significant role as the platform provider, the stakeholders influencing the experiences are multifaceted. Hosts, guests, local communities and even regulatory bodies all contribute to shaping the overall Airbnb Experience ecosystem. Hosts, in particular, have a crucial role in curating and delivering unique experiences, which significantly impacts the quality and authenticity of the offerings. On the question of whether Airbnb offers an authentic travel experience, the review uncovered mixed findings. For examples, some studies emphasized the potential for Airbnb to provide authentic and local experiences, allowing travelers to engage with the community and cultural aspects of a destination. However, other studies raised concerns about the commodification and standardization of experiences, leading to a potential loss of authenticity. Originality/value – This paper is different from previous SLR where previous research systematically reviewed; motivations to use and choose Airbnb, institutionalization of Airbnb, stakeholders of Airbnb. This paper addresses authentic experience as a factor that influences activity participation.