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Diet is a contributor to the pathogenesis of many non-communicable diseases. Among contributors to poor diet is high added sugar consumption, which is unfortunately on the rise nowadays. The recommended sugar intake by The American Heart Association (AHA) is 24g/day and 36g/day for women and men, respectively. The study's aim is to assess added sugar intake among adults in Saudi Arabia. A cross-sectional study design was used via an online survey among adults in Saudi Arabia using convenience sampling, and social media platforms were used to collect the data. The authors conducted descriptive statistics to present demographic variables using Chi-square χ2 tests for categorical and t-tests for continuous variables. All statistical tests used a 95% confidence interval with a two-sided P-value <0.05 as significance level. A total of 1163 respondents were included in the study. The study has shown an overall added sugar intake average of 73 g/day. There was a significant difference in means of overall added sugar intake across genders for the age group 18–30 and the age group >60. Equivalently, there was a statistically significant difference in means of added sugar intake food across gender (P-value 0.008). Females tended to consume more added sugar in their food than males. The highest consumption was in the Northern region (123.71 g/day), followed by the Southern region (98.52 g/day), the Western region (86.14 g/day), and lastly, the Central and Eastern regions (66.95 and 62.02 g/day, respectively). The total added sugar intake of added sugar is extremely high in Saudi Arabia. Poor dietary habits lead to many adverse health consequences, including obesity and diabetes. Healthcare providers and public health officials are highly encouraged to shed light on added sugar consumption and create opportunities to promote healthy dietary patterns. The Saudi population is recommended to abide by the added sugar dietary recommendations to avoid future chronic medical conditions. [ABSTRACT FROM AUTHOR]

Purpose: For patients with a failed forearm autogenous fistula (AF) and an exhausted cephalic vein, there is controversy about whether a brachial basilic AF with transposition or an arteriovenous prosthetic bridging graft (BG) must be the second vascular access option. This work measured and compared these two modalities according to patency rates, complications, and revisions. Patients and methods: A retrospective study of 104 cases that had either a brachial basilic AF (72) or an Arteriovenous BG (32). Technical success, operative complications, procedure-related mortality, maturation time, functional primary, secondary, and overall patency rates were all assessed. Results: Technical success was obtained in all participants. No procedure-linked mortality. Maturation time for BGs was significantly shorter than AFs. The complication rate was significantly higher in BGs than in AFs. The most prevalent complication was access thrombosis. The functional primary patency rate was significantly higher in AF than in BG at 12-month follow-up: 77.7% vs 53.1% (P < 0.012). secondary patency rate was higher in AF than in BG at 1-year follow-up 62.5% vs 42.8% (P = 0.063), respectively. In addition, BGs required more interventions to preserve patency. Conclusions: AF had higher primary, secondary and overall functional patency rates and needed fewer procedures to keep patency than BGs. Cases that need early vascular access as a result of central venous catheter complications or who have a reduced life expectancy may benefit from BGs. [ABSTRACT FROM AUTHOR]

We aimed to conduct a systematic review and meta-analysis to compare the efficacy and safety of titrated oral misoprostol versus static oral misoprostol for labour induction. We searched for the available randomised clinical trials (RCTs) in the Cochrane Library, PubMed, ISI web of science, Scopus, and ClinicalTrials.gov. We included RCTs compared titrated oral misoprostol versus static regimen of oral misoprostol during labour induction. Our main outcomes were vaginal and caesarean delivery rates, uterine tachysystole, misoprostol side effects, and neonatal adverse events. Three RCTs met our inclusion criteria with a total number of 360 patients. The vaginal delivery rate did not significantly differ between both groups (p = 0.49). Titrated oral misoprostol was associated with significant increase in the caesarean delivery rate compared to static oral misoprostol (p = 0.04). Moreover, titrated oral misoprostol led to significant increase in the uterine tachysystole and misoprostol side effects (p = 0.01 & p = 0.003, respectively). There were no differences among both groups regarding different neonatal adverse events. In conclusion, titrated oral misoprostol increases the incidence of caesarean delivery, uterine tachysystole, and misoprostol side effects with a similar vaginal delivery rate compared to static dose misoprostol. Thus, static oral misoprostol should be used instead of titrated oral misoprostol during labour induction. What is already known on this subject? Different studies have evaluated titrated oral misoprostol administration for induction of labour and proved their efficacy in comparison with other induction methods. However, there is controversy among the published studies between titrated oral misoprostol and static oral misoprostol during induction of labour. A recent study concluded that hourly titrated misoprostol and static oral misoprostol are equally safe and effective when utilised for induction of labour with no fear of any adverse events. However, another study recommended static oral misoprostol administration for labour induction as it was linked to a lower caesarean section incidence, fewer drug side effects, and decline in complication rates in comparison with titrated oral misoprostol. What the results of this study add? Titrated oral misoprostol increases the incidence of caesarean delivery, uterine tachysystole, and misoprostol side effects with a similar vaginal delivery rate compared to static dose misoprostol. What the implications are of these findings for clinical practice and/or further research? Static oral misoprostol should be used instead of titrated oral misoprostol during labour induction. More future trials are required to confirm our findings. [ABSTRACT FROM AUTHOR]

Drainage water in developing countries has a high abundance of pathogenic bacteria and high levels of toxic and mutagenic pollutants. Remediation of drainage water is important in water-poor counties, especially with the growing need to secure sustainability of safe water resources to fulfill increasing demands for agriculture. Here, we assess the efficiency of macrophyte Pistiastratiotes to remediate a polluted drain in Egypt, rich in macronutrients, heavy metals, and different types of pathogenic and non-pathogenic bacteria. Drainage water was sampled monthly, for a year, to assess seasonal changes in bacterial abundance, water physicochemical properties (transparency, temperature, dissolved oxygen, EC, pH, N, P, and K), and heavy metals contents (Pb, Zn, and Co) in a polluted drain dominated with P.stratiotes. The ability of P.stratiotes to rhizofiltrate the three heavy metals was calculated. The results showed seasonal variations in the plant rhizofiltration potential of Co and Salmonella abundance. The highest values of dissolved oxygen (12.36 mg/L) and macronutrient elements (N and P) were attained in the winter. The counts of total coliform, fecal coliform, fecal streptococci, and in Salmonella spp. were the highest in the summer. P.stratiotes accumulated Pb more than Zn and Co. The highest levels of rhizofiltration were in summer for Pb and Co and in the autumn for Zn. Canonical correspondence analysis (CCA) showed that the variation in the bacterial abundance and plant rhizofiltration potential was strongly and significantly affected by water-dissolved oxygen. Moreover, the rhizofiltration potential of Pb and Co showed a positive correlation with water N. Overall, P.stratiotes could be proposed as a potential biomonitor for heavy metals in polluted water. [ABSTRACT FROM AUTHOR]

Objective: To study the association of the grade of vesicoureteral reflux (VUR) and urinary tract infections (UTI) with renal scarring at the first clinical presentation of patients who underwent antireflux surgery. Materials and methods. Between 2015 and 2020, 150 patients (194 units) who underwent antireflux surgery had dimercaptosuccinic acid (DMSA) renal scans preoperatively. Patients were classified into the nonscar and scar groups according to DMSA scan results. Moreover, cases were classified into afebrile UTI, febrile UTI, and antenatal hydronephrosis (ANH) according to the mode of presentation. We correlated the mode of presentation and the grade of VUR to the presence/absence of renal scars in both groups.Results: The mean follow-up was 45 months preoperatively. The mode of presentation was afebrile, febrile UTIs, and antenatal hydronephrosis in (50, 14), (20, 46), and (10, 10) patients in the nonscar and scar groups, respectively. Of the 20 patients who presented ANH, 10 (50%) had scars. Clinical presentation was correlated to the presence of renal scarring and its degree. The scar group had significantly higher grades of VUR than the nonscar group (grades I-II (50 units versus 10 units), grade III (28 units versus 40 units), and grade IV-V (22 units versus 44 units) for the nonscar versus scar groups, respectively (pvalue <0.001).Conclusion: Renal scarring is associated with higher grades of reflux and urinary tract infections. We advocate further research investigating infants who had UTIs with or without fever for early detection of reflux. [ABSTRACT FROM AUTHOR]

This paper comprehensively analyzes the geochemical, mineralogical and petrographical properties combined with bulk kinetics modeling of the Domanik organic-rich carbonate from various depth intervals in Kuzminovsky oilfield (well № 26 R), Volga-Ural Basin, Russia. The results show that, the Domanik carbonate-rich samples are characterized by high content of the total organic matter (TOC) up to 13.31 wt %, and contain mainly Type II kerogen with a slight II/III kerogen type, reaching very good to excellent oil generation potential. Moreover, the studied samples contain hydrogen-rich kerogen, which expected to generate paraffin, naphthene and aromatic (P–N-A) oil with low wax content as demonstrated by the Py-GC Pyrolysis combined with the abundance of fluorescent alginite, amorphous organic matter, and bituminite as established from investigations via microscope. The maturity indicators demonstrated that, most of the examined Domanik carbonate-rich samples, with a burial depth between 1726.5 m and 1784.9 m, have generally reached low thermal maturity stages; thus, defining an immature to moderate-mature of oil generation window. The results of the kinetic models suggested that, Domanik carbonate-rich rocks with vitrinite reflectance (VRo) values in the range of 0.60–0.71%, have reached relatively low kerogen transformation ratio in the range of 10–20%, indicating low probability oil generation. These finding are confirmed by the presence of low oil saturation index of less than 100 mg HC/g rock (19.64–69.97). In addition, the results of thin section, scanning electron microscopy (SEM) and micro-computed tomography (micro-CT) showed that the studied samples are characterized by low porosity (up to 3.29%) with a wide pores size range, including interparticle, cavities, cracks and organic matter pores. The development of these pore types and their quality in the studied samples is mainly controlled by high mineralogical brittleness (i.e., carbonate and quartz) together with the high organic matter inputs. Therefore, according to the obtained results, characteristics and observations, the Domanik Formation has a high potential for commercial oil production, which typically requires hydraulic fracturing followed by an in-situ retort, mainly by thermal methods such as steam injection and in situ combustion process. • Domanik Formation reached excellent petroleum generation with TOC values up to 13.31 wt %. • Domanik rocks have a total porosity of 2.35% and 3.29% as developed from interparticle, cavities, cracks and OM pore sizes. • Kinetic models result show that the peak of oil generation predicted at geological temperatures between 138 and 142 °C. • Domanik formation considered to be unconventional oil reservoir potential. • Domanik carbonate-rich rocks are suitable for conducting hydraulic fracturing for commercial oil production. [ABSTRACT FROM AUTHOR]

• Trait-environment and distribution models are tools for invasion risk assessment. • Salvia rosmarinus, Eucalyptus globulus & Acacia saligna are invasion indicators. • Assessing invasion risk at microhabitat scale is strong tool for local conservation. • Wadis in SKP are threatened by invasion risk, they are priority conservation areas. • An increase in precipitation & temperature seasonality indicates high invasion risk. Invasive species are considered as one of the key threats to biodiversity and human livelihoods globally. The most effective strategy for handling invasion would be based on profiling invasive species and identifying areas at risk of invasion before they occur. The current study used a trait-environment modelling approach to identify alien species with high probability of invasiveness and combined this with the species distribution models (SDMs) to predict areas in the arid Saint Katherine Protectorate (SKP) in Egypt that were at highest risk of invasion by these species. The specific leaf area, number of leaves, soil nitrogen, and prevalence of disturbances were the most important biotic and abiotic indicators for predicting invasiveness in SKP. Of the investigated 33 alien plant species, three species were identified to have the highest probability of invasiveness, including Salvia rosmarinus, Eucalyptus globulus, and Acacia saligna. The outcome of the SDMs revealed that precipitation seasonality and temperature-related variables were the most important bioclimatic predictors determining the potential invasion risk of the studied alien species. Potential invasion is more likely in the eastern and northern parts of SKP, where biodiversity-rich common microhabitats are found and where there is a prevalence of disturbances such as tourism activities. The Etalaa, Shaq Mosa, and El-Mesirdi wadis microhabitats, in particular, were identified in the current study to be potentially highly suitable microhabitats for alien invasiveness and should be prioritized for monitoring and conservation actions. Moreover, the three identified species could be used as early indicators for microhabitats at risk of invasion along the environmental gradients of temperature and precipitation in arid ecosystems. This approach can be applied to other taxa and other ecosystems and can provide opportunities for formulating proactive management strategies against biological invasions. [ABSTRACT FROM AUTHOR]

Background: Climate changes have led to health and environmental risks, so it has become essential to measure climate change literacy among the entire population, especially nursing students. The significant role of nursing students in raising public awareness and future healthcare roles emphasizes assessing the predictors of climate change literacy among nursing students., Aims: This study seeks to identify the predictors of climate change literacy among nursing students in A Multi-Site Survey., Design: A multi-site descriptive cross-sectional study adheres to the guidelines outlined in A Consensus-Based Checklist for Reporting Survey Studies collected for five months, from the 1st of July 2023 to November 2023. The study participants comprise 10,084 nursing students from all 27 governments in Egypt. The researcher used the Predictors of Nursing Students' Climate Change Literacy scale in this study. Data was collected, with 25 min average time to complete. Backward multiple linear regression was used to identify these predictors., Results: In the current study, nursing students demonstrated a moderate understanding of climate science (mean score 14.38), communication and advocacy skills (mean score 14.41), and knowledge of adaptation and mitigation strategies (mean score 13.33). Climate health impacts (mean score 17.72) emerged as the domain with the highest level of knowledge. No significant differences in climate literacy were observed across diverse student backgrounds (all p-values were > 0.05). Perceived faculty knowledge of climate change positively correlated with all four domains of climate literacy and emerged as a significant predictor in multiple linear regression analyses (all p-values were < 0.001)., Implication: While our findings highlight significant predictors of climate literacy, it is essential to recognize that these results identify associations rather than causal relationships. Based on these associations, it is recommended that nursing professionals be equipped with comprehensive knowledge of climate adaptation strategies to better advocate for and implement effective public health measures., (© 2024. The Author(s).)

One of the most crucial steps in the practical conservation of endangered endemic mountain plants is to address their population size status and habitat requirements concurrently with understanding their response to future global warming. Three endangered Silene species- Silene leucophylla Boiss., S. schimperiana Boiss., and S. oreosinaica Chowdhuri-in Egypt were the focus of the current study. These species were examined for population status change, habitat quality variables (topography, soil features, and threats), and predictive current and future distributions. To find population size changes, recent field surveys and historical records were compared. Using Random Forest (RF) and Canonical Correspondence Analysis (CCA), habitat preferences were assessed. To forecast present-day distribution and climate change response, an ensemble model was used. The results reported a continuous decline in the population size of the three species. Both RF and CCA addressed that elevation, soil texture (silt, sand, and clay fractions), soil moisture, habitat-type, chlorides, electric conductivity, and slope were among the important variables associated with habitat quality. The central northern sector of the Saint Catherine area is the hotspot location for the predictive current distribution of three species with suitable areas of 291.40, 293.10, and 58.29 km 2 for S. leucophylla, S. schimperiana, and S. oreosinaica, respectively. Precipitation-related variables and elevation were the key predictors for the current distribution of three Silene species. In response to climate change scenarios, the three Silene species exhibited a gradual contraction in the predictive suitable areas with upward shifts by 2050 and 2070. The protection of these species and reintroduction to the predicted current and future climatically suitable areas are urgent priorities. Ex-situ conservation and raised surveillance, as well as fenced enclosures may catapult as promising and effective approaches to conserving such threatened species., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Abdelaal, AL-Huqail, Alghanem, Alhaithloul, Al-Robai, Abeed, Dakhil, El-Barougy and Yahia.)

Background: The dual technique using blue dye in combination with a radioisotope is considered the gold standard for identifying sentinel lymph nodes (SLNs) in patients with breast cancer. Unfortunately, not all cancer centres have access to radioactive material, which jeopardizes the SLN identification rate and patient safety., Aim: We aimed to assess the safety and efficacy of mitoxantrone hydrochloride injection (MHI) for identifying axillary SLNs in patients with primary breast cancer., Patients and Methods: We have conducted a prospective non-randomized analysis of patients diagnosed with invasive breast cancer who agreed to participate in the study between December 2019 and December 2022. We have used the patient's medical records to collect the data. We have used the SLN intraoperative identification rate as a marker for the efficacy of the technique and both the immediate and delayed complication rates and routine blood tests as markers for the safety of the technique., Results: Out of the 296 patients, 289 (97.6%) had their SLNs identified using MHI, while seven patients (2.3%) had four-node sampling carried out because the SLNs were not identified. Liver functions were not significantly affected by MHI, and there was no technique-related readmission or reported morbidity or mortality., Conclusion: We have found that the MHI technique is still inferior to the combined radioactive directed technique and patent blue V dye in SLN identification. Yet, it may serve as a safe and reliable alternative in cases where the radioactive technique is unavailable., (© 2023. The Author(s) under exclusive licence to Société Internationale de Chirurgie.)

Background: The effect of bariatric surgery on impaired semen parameters, hormonal profile and sexual function remains controversial to some extent., The Context and Purpose of the Study: To look at the long-term effects of sleeve gastrectomy on hormonal profiles, sperm parameters, and sexual function in infertile men with severe obesity. This prospective study included fifty-four obese patients with primary or secondary infertility who were scheduled for sleeve gastrectomy between February 2018 and March 2021. All participants were given a sperm analysis and a serum hormone profile before, 12, and 18 months after surgery. We used the International Index of Erectile Function questionnaire to assess sexual function., Results: There was a significant correlation between weight loss after sleeve gastrectomy and improvement in lipid profile (p < 0.05). No significant detectable effect of post-gastrectomy weight loss on patients with diabetes mellitus, hypertension, or obstructive sleep apnea. As regards the hormonal profile, sex hormone binding globulin, total and free testosterone improved significantly after 12- and 18-months following sleeve gastrectomy. There was a significant increase in sperm count and total sperm number during the follow-up after sleeve gastrectomy (p < 0.05), however, there were no significant changes in other semen parameters. Concerning sexual function, sexual desire, erectile function, and satisfaction improved significantly at 12 and 18 months after surgery., Conclusion: Weight loss through sleeve gastrectomy surgery significantly improves testosterone deficiency, sexual performance, and Sperm count in obese infertile men., (© 2023. The Author(s).)

Benefiting from the additional active sites for sodium-ion (Na + ) adsorption and porous architecture for electrolyte accessibility, nitrogen-doped porous carbon has been considered the alternative anode material for Na + -storage applications. In this study, nitrogen-doped and zinc-confined microporous carbon ( N,Z -MPC) powders are successfully prepared by thermally pyrolyzing the polyhedral ZIF-8 nanoparticles under an argon atmosphere. Following the electrochemical measurements, the N,Z -MPC not only delivers good reversible capacity (423 mAh/g at 0.02 A/g) and comparable rate capability (104 mAh/g at 1.0 A/g) but also achieves a remarkable cyclability (capacity retention: 96.6% after 3000 cycles at 1.0 A/g). Those can be attributed to its intrinsic characteristics: (a) 67% of the disordered structure, (b) 0.38 nm of interplanar distance, (c) a great proportion of sp 2 -type carbon, (d) abundant microporosity, (e) 16.1% of nitrogen doping, and (f) existence of sodiophilic Zn species, synergistically enhancing the electrochemical performances. Accordingly, the findings observed here support the N,Z -MPC to be a potential anode material enabling exceptional Na + -storage abilities.

Objectives: To assess safety; efficacy and efficiency of mini-sternotomy in aortic valve replacement in comparison to conventional sternotomy on short term follow up., Method: This comparative study between 45 patients having aortic valve replacement via fullsternotomy versus 45 others planned for upper j-shaped mini-sternotomy, was conducted from May 2019 to February 2022 in Kafrelsheikh university hospital, Egypt. Data was collected and statistically analysed to assess outcomes., Results: Mini-Sternotomy approach was compared to conventional approach on the aspects of cardio pulmonary bypass (CPB) (p=0.153) and cross clamp (CC) time (p=0.673),. There was significantly less postoperative bleeding (p<0.001), rate of blood transfusion (p<0.001), duration of ICU stay (p=0.013) and total hospitalstay (p=0.022) in ministernotomy approach in comparison to conventional sternotomy., Conclusions: For primary isolated AVR, lessinvasive techniques are a realistic, practical, and good alternative that offers better postoperative results than Full Sternotomy.

Objectives: To compare the outcome of off-pump and on-pump coronary artery bypass graftsurgery in patients with left main coronary artery disease., Methods: The randomised, controlled, prospective, multicentric study was conducted in 2020 during the period from January 2020 to December 2020 at Kafrelsheikh University Hospital, International Cardiac Centre and Alexandria New Medical Centre, Egypt, and comprised patients with left main coronary artery disease who underwent coronary artery bypass graftsurgery. The patients were randomised to on-pump surgery group I (Control Group) and off-pump surgery group II(Interventional Group). All patients were assessed pre-operatively for the presence of comorbid conditions and post-operatively for myocardial infarction, acute kidney injury, pneumonia, sternal dehiscence and 3-month mortality. Data was analysed using SPSS 20., Results: Of the 60 patients, 44(73.3%) were men and 16(26.6%) were women. The overall mean age was 66.4±9.2 years. There were 30(50%) patients in each of the two groups. There were 2(6.7%) cases of myocardial infarction in group I and 1(3.3%) in group II. There was 1(3.3%) case of acute kidney injury in group I and none in group II. There were 3(10%) cases of pneumonia in group 1 compared to 1(3.3%) in group II. There was 1(3.3%) case of sternal dehiscence in group I and none in group II. Mortality at 3 months was 2(6.7%) in group I and 1(3.3%) in group II. There was no significant difference with respect to outcome between the groups (p>0.05)., Conclusions: Off-pump coronary artery bypass graft surgery was found to be efficient and non-inferior to on-pump procedure in patients with left main coronary artery disease., Rct Registration: The RCT was registered retrospectively at the Pan African Clinical Trials Registry (PACTR) (Trial #: PACTR202301506140749 Date of Approval: 06/01/2023). Link: https://pactr.samrc.ac.za/Search.aspx.

Objectives: To determine the effect of flippits versus virtual reality on pain, fear and satisfaction among children during phlebotomy., Method: The quasi-experientialstudy was conducted at the Paediatric Medical Department of Kafrelsheikh University Hospital, Egypt, from November 2021 to April 2022, and comprised children of either gender aged 6-12 years. The subjects were randomised into flippits group A, virtual reality group B and control group C in which only traditional care was provided. Data was collected using a structured interview, Wong-Baker Faces Pain Rating Scale, Children's Fear Scale, and Blood Specimen Collection Satisfaction Evaluation Scale. Data was analysed using SPSS 20., Results: Of the 120 children, 40(33.3%) were in each of the three groups. There were 21(52.5%) boys and 19(47.5%) girlsin group A with mean age 8.2±1.6 years, 22(55%) boys and 18(45%) girlsin group B with mean age 7.8±1.7 years, and 27(67.5%) boys and 13(32.5%) girls in group C with mean age 7.9±1.9 years (p>0.05). Mean pain and fear scores were significantly lower and mean satisfaction score was higher in groups A and B than group C (p<0.05). There was no significant difference in the mean pain scores of group A and group B (p>0.05)., Conclusions: Flippits and virtual reality interventions had a positive effect on pain, fear and satisfaction levelsin children during phlebotomy.

Polyostotic fibrous dysplasia is a rare benign asymptomatic tumour of the ribs not requiring surgery on most occasions. We present here a case with left 10th and 11th rib fibrous dysplasia which was causing a hinderance to the Urologist for renalstone extraction. Therefore the 10th and 11th ribs were excised followed by chest wall reconstruction.

Objectives: To evaluate the relationship between left ventricular hypertrophy (LVH) and coronary artery bypass grafting (CABG) procedure especially on the early outcome during the first 6 months following surgical intervention., Method: This prospective cohort study included 82 patients with coronary artery disease indicating CABG. These patients were admitted, operated and followed -up in cardiothoracic surgery departmentsin the faculty of medicine, Kafrelsheikh university hospitals in the period from April 2019 till November 2021.The patients included in this study were divided into two groups according to presence or absence of left ventricular hypertrophy, Group I had 38 (46.34%) patients with LVH and Group 2 had 44 (53 .65%). patients without LVH., Results: The time to regain mechanical activity waslonger (5.76±1.82) minutesin LVH patients(p <0.001). LVH group had a significantly longer period of mechanical ventilation 16.50±4.25 hours (p <0.001) compared to non LVH group which was 9.61±3.78 hours. Also, the mean duration of ICU stays in the LVH group compared to the non LVH group was 3.81±1.20 days versus 2.56±0.81 daysrespectively. The ICU follow up showed a statistically significant relationship of arrhythmias with LVH (p =0.022), infections (p =0.005) and wound infections (p<0.001)., Conclusions: In patients undergoing CABG surgery, LVH has been associated with increased morbidity and poor outcome.

Objective: The aim of this study is to investigate the effectiveness of pulsed Nd:YAG high-intensity laser therapy (HILT) on body weight (Wt), body-mass index (BMI), waist circumference (WC), forced vital capacity (FVC), and forced expiratory volume in 1 sec (FEV1) in young adults with abdominal obesity (AO). Materials and methods: Thirty-seven young adult males (age 19-25 years) with BMI >30 kg/m 2 and WC >102 cm participated in this 12-week, randomized controlled study and were randomly allocated into either Group I [received pulsed Nd:YAG HILT plus moderate-intensity aerobic exercise training (AET) program] or Group II (received placebo pulsed Nd:YAG HILT plus the same AET program). The variables were evaluated pre- and poststudy. Results: Poststudy mean values and percentages of changes were calculated for Wt [83.7 ± 6.58 kg (-6.14%) and 88.71 ± 5.09 kg (-4.29%)], BMI [29.27 ± 1.06 kg/m 2 (-6.14%) and 30.09 ± 1.23 kg/m 2 (-4.24%)], WC [105.44 ± 5.84 cm (-3.78%) and 109.42 ± 4.9 cm (-1.74%)], FVC [4.79 ± 0.4 L (+13.6%) and 4.39 ± 0.66 L (+5.89%)], and FEV1 [4.04 ± 0.22 L (+16.4%) and 3.82 ± 0.39 L (+8.8%)] for Group I and Group II, respectively. Between groups, there were significant differences in mean values of Wt ( p  = 0.014), BMI ( p  = 0.04), WC ( p  = 0.03), FVC ( p  = 0.03), and FEV1 ( p  = 0.04) at the end of the study, but in favor of Group I. Conclusions: Utilizing the pulsed Nd:YAG HILT as an adjunctive therapeutic modality proved to be effective in improving the anthropometric indices and ventilatory functions in subjects with AO.

Background: Age-related complex medical conditions have been commonly reported among adolescents and young adults with advanced life-limiting illness. There is increasing interest in exploring their palliative care needs and end-of-life experiences., Aim: This scoping review aimed to explore the available literature about providing palliative and end-of-life care to adolescents and young adults with advanced life-limiting illnesses., Design: Scoping review. This review was registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/SPTD7)., Data Sources: Electronic databases (MEDLINEALL, Embase, Emcare, Cochrane Central Register of Controlled Trial CENTRAL, Scopus, PsycINFO, Cochrane Database of Systematic Reviews), Google Scholar and reference lists were searched up to October 2021. We included studies reporting on adolescents and/or young adults with advanced life-limiting illnesses. There were no limitations concerning location, type of illness or study design., Results: We identified 51 studies published between 2002 and 2021. Most studies were published in the United States ( n  = 34, 67%), and nine studies (18%) reported exclusively on patients with non-malignant illnesses. Two thirds of the identified studies were case reports and retrospective chart reviews ( n  = 33). Three main topics were identified: Physical symptom burden ( n  = 26, 51%), Psychological and social needs ( n  = 33, 65%), and end-of-life care ( n  = 30, 59%). Twenty-six studies (51%) were focused only on one topic, and the age range used to identify adolescents and young adults varied based on the study location., Conclusion: The findings of this review shed light on the different palliative care experiences and knowledge gaps related to adolescents and young adults as an underserved and vulnerable patient population. Further research needs to be dedicated toward palliative care programs tailored for adolescents and young adults.

Objective: To evaluate the role of urinary Monocyte Chemotactic Protein-1 (MCP1) and urinary epidermal growth factor (EGF) in diagnosing of upper urinary tract obstruction (UUTO)., Patient and Methods: Over a period of 6 months (January 2022 to June 2022) this prospective case control comparative study was conducted on 120 participants, 60 of them with UUTO and 60 healthy controls. A morning urine sample of all participants was tested for EGF and MCP-1. after taking a detailed history taking and laboratory and radiological evaluation., Results: Urinary MCP-1(uMCP-1) was significantly (p-value = 0.000) increased in UUTO group showing a mean ± SD of 518.10 ± 51.19 ng/L compared to a mean ± SD of 143.32 ± 58.03 ng/L in the controls, whereas a significantly (p-value = 0.000) decrease of urinary EGF (uEGF) was observed in patients with UUTO compared to control group. A significant difference of uEGF level and uEGF/uMCP1 ratio was observed between mild compared to moderate/severe UUTO., Conclusions: Utilization of the urinary biomarker MCP1, EGF and uEGF/uMCP1 ratio in patients with UUTO can adequately be used as a simple, efficacious and noninvasive way in diagnosis of UUTO.

Objective: To evaluate and compare the outcome of ECIRS in the treatment of partial staghorn renal calculi in both prone split-leg positions versus GMSV positions with regard to; technical aspects, success rate, operative time, complications, safety, and effectiveness of both approaches., Patients and Methods: Between October 2018 and August 2021, 66 patients with partial staghorn calculi were enrolled in this prospective comparative study. Patients were randomly divided according to a 1:1 ratio into two groups. Group A included 33 patients who were treated by (ECIRS) in the prone split-leg position, and group B included 33 patients who were treated by (ECIRS) in the Galdakao-modified supine Valdivia (GMSV) position., Results: No significant statistical difference between both groups regarding the mean age (p = 0.448), mean body mass index (BMI) (p = 0.137), mean stone burden (p = 0.435), mean operative time (p = 0.541) and the number of calyces located in branched stones (p = 0.628). The mean hospital stay was 6.71 ± 1.12 days for group A and 6.66 ± 1.10 days for group B patients (p = 0.724). The final SFR was achieved in (29)87.87% and (30)90.9% of group A & B patients, respectively (p = 0.694). No significant difference was detected between both groups in perioperative complication rates., Conclusion: ECIRS is safe and effective in treating partial staghorn calculi either in the prone split-leg position or in the Galdakao-modified supine Valdivia position, with comparable outcomes and no statistically significant difference between both positions., (© 2022. The Author(s).)

Colorectal cancer therapies have produced promising clinical responses, but tumor cells rapidly develop resistance to these drugs. It has been previously shown that EC19 and EC23, two EC-synthetic retinoids, have single-agent preclinical anticancer activity in colorectal carcinoma. Here, isobologram analysis revealed that they have synergistic cytotoxicity with retinoic acid receptor (RAR) isoform-selective agonistic retinoids such as AC261066 (RARβ2-selective agonist) and CD437 (RARγ-selective agonist) in Caco-2 cells. This synergism was confirmed by calculating the combination index (lower than 1) and the dose reduction index (higher than 1). Flow cytometry of combinatorial IC 50 (the concentration causing 50% cell death) confirmed the cell cycle arrest at the SubG 0 -G 1 phase with potentiated apoptotic and necrotic effects. The reported synergistic anticancer activity can be attributed to their ability to reduce the expression of ATP-binding cassette (ABC) transporters including P-glycoprotein (P-gp1), breast cancer resistance protein (BCRP) and multi-drug resistance-associated protein-1 (MRP1) and Heat Shock Protein 70 (Hsp70). This adds up to the apoptosis-promoting activity of EC19 and EC23, as shown by the increased Caspase-3/7 activities and DNA fragmentation leading to DNA double-strand breaks. This study sheds the light on the possible use of EC-synthetic retinoids in the rescue of multi-drug resistance in colorectal cancer using Caco-2 as a model and suggests new promising combinations between different synthetic retinoids. The current in vitro results pave the way for future studies on these compounds as possible cures for colorectal carcinoma.

Multidrug resistance (MDR) means that tumour cells become unresponsive during or after the course of treatment to one or more of chemotherapeutic drugs. Chemotherapeutic resistance critically limits the treatment outcomes and remains a key challenge for clinicians. The alternation in intracellular drug concentration through the modulation of its transport across the plasma membrane is the major cause for MDR and is adopted by various mediators, including ATP-requiring enzymes (ATPases). Among these ATPases, ABC transporters have been extensively studied, and found to be highly implicated in tumorigenesis and MDR. The present review sheds light on the documented effects of retinoids on ABC enzymes to understand their mechanism in combating cancer cell resistance. This would open the gate to test the mechanism and applicability of different new synthetic retinoids in literature and market as modulators of ATP-dependent efflux pumping activity, and promote their applicability in diminishing anti-cancer drug resistance.

Purpose: We evaluated the impact of structural versus nonstructural bone grafting on the time to union, scaphoid deformity correction, and clinical outcomes in adults with unstable scaphoid waist nonunion without avascular necrosis. We hypothesized that nonstructural grafting would provide earlier time to union, restoration of scaphoid anatomy, and equivalent clinical outcomes compared with structural grafting., Methods: We prospectively randomized 98 patients to undergo open reduction, iliac crest bone grafting with either corticocancellous (CC group) or cancellous bone only (C-only), and internal fixation using a Herbert screw. The lateral intrascaphoid angle (LISA) and scaphoid height length ratio (HLR) were measured on wrist computed tomography scans along the scaphoid longitudinal axis before surgery and an average of 84 weeks afterward. Pain, range of motion, grip strength, and Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score were measured before surgery and an average 84 weeks afterward., Results: The trajectory of scaphoid union showed a higher union rate of the C-only group at 12, 14, and 16 weeks after surgery. However, at 24 weeks after surgery, there was no difference between the groups, The union rate was 94% in patients treated with C-only and 90% with CC grafting. In patients with preoperative LISA less than 70° and/or HLR less than 0.80 (n = 53), there were no differences between the CC and C-only grafting techniques for radiographic and clinical outcomes, QuickDASH scores, and malunion rate. In patients who had preoperative LISA greater than 70° and/or HLR greater than 0.80 (n = 45), radiographic outcome measures, range of motion, and QuickDASH scores were significantly better in the CC than in the C-only group. Scaphoid malunion was observed in 9 of 22 of C-only patients (41%) and 4 of 23 of CC patients (18%)., Conclusions: The severity of the scaphoid deformity may be a factor in determining the best graft type, because this may affect the rate of successful deformity correction. Corticocancellous grafting in patients who had a high degree of scaphoid deformity provided consistent deformity correction and superior QuickDASH scores. Otherwise, C-only grafting provides earlier time to union and equivalent clinical and radiographic outcomes compared with CC grafting., Type of Study/level of Evidence: Therapeutic I., (Copyright © 2021 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Background: Warts, or verrucae, are mucosal human papilloma virus (HPV) infections that are very challenging to treat., Objective: To compare the safety and efficacy of intralesional injection of vitamin D3 versus intralesional injection of candida albicans antigen for plantar warts., Methods: Forty patients were included in the study and were divided into two groups (A&B) with 20 patients each. Group A received intralesional vitamin D3 while Group B received intralesional Candida antigen. Injection was done every 3 weeks until clearance of warts or a maximum of three treatments., Results: Nine patients showed complete clearance in group A (45%), while 6 patients (30%) showed partial response and no response in 5 patients (25%) of group (A). As for group (B), complete clearance of the treated warts was observed in 8 patients (40%), partial response in 6 patients (30%) while no response was observed in 6 patients (30%). No superiority of one treatment to the other was observed nor was any statistical significance in both groups&rsquo; responses noted., Conclusion: Treatment of multiple warts by intralesional injection of candida antigen or vitamin D3 is safe and effective, with good cure rates, has an excellent safety profile, with minimal recurrences and statistically equivalent. J Drugs Dermatol. 2021;20(5):546-549. doi:10.36849/JDD.5264.

Objective: To analyse the rates and reasons for donor deferral at a blood bank in Saudi Arabia., Methods: This retrospective study was conducted at King Abdulaziz Medical City, Jeddah, Saudi Arabia, and comprised data of all blood donors reporting for donation from January 2011 to December 2014 in the hospital's blood bank, accredited by the American Association of Blood Banks. Data was collected from the records maintained by the blood bank., Results: Out of the 46,370 blood donors, 4,035(8.7%) were deferred. Of them, 764(19%) were deferred because of persistent high pulse rate, 689(17%) poor veins, 488(12%) low blood pressure and 74(1.8%) because of low haemoglobin., Conclusions: Reasons for deferral may vary due to difference in socio-economic status, and cultural and environmental factors.

We report a case of a 30-year-old female who had been treated periodically with steroids for idiopathic thrombocytopenic purpura ITP over the last 10 years. Recently, during the course of investigation, she was found to have incidental asymptomatic multiple pulmonary nodules on chest CT. Following a needle biopsy to exclude malignancy, 2 nodules were excised and were histologically confirmed as pulmonary hyalinizing granuloma PHG. The remaining 2 nodules regressed on increasing her dose of steroids. The case is discussed with emphasis on the histological and radiological differential diagnosis, in addition to including ITP among the spectrum of immunologic conditions associated with PHG.

We evaluated the efficacy of combined surgical and endovascular treatment of high-risk dural arteriovenous fistulas (AVFs) with retrograde leptomeningeal venous drainage. Of 92 patients with intracranial dural AVF, 14 underwent combined surgical and endovascular treatment. Dural AVF was located in the cavernous sinus in two, the petrotentorial region in one, and the transverse-sigmoid sinus in 11. Characteristic features of the patients were retrograde leptomeningeal venous drainage and obstruction of transvenous access routes. All the patients were treated with combined transarterial embolisation and surgical procedures including craniotomy and sinus packing with coils, or clipping of the draining vein. Dural AVF was completely obliterated in all patients without obvious neurologic complications. In the mean follow-up period of 4.2 years, a new dural AVF on the cortex adjacent to the treated sinus developed in one patient. Combined surgical and endovascular treatment is effective for the treatment of high-risk dural AVFs.