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The study aimed to determine the impact of artificial intelligence techniques on the development of the role of management accountants while exploring the extent of the awareness of management accountants of the importance of artificial intelligence techniques, and the study reached a set of results, the most important of which is that expert systems enable management accountants to store and interpret human experience and use it in providing advice and advice to management accountants and help reach appropriate decisions in the light of the evidence provided to expert systems, and data analytics enable the management accountant to detect patterns New relationships in large amounts of data to reach a lot of conclusions that benefit decision makers in companies, and neural networks enable the solution of complex problems in the fields of machine learning, systems engineering, market forecasting, complex systems, continuous improvement of systems, processes, non-linear systems, financial and economic analysis, the study also recommended the need for governments to provide strong support for the application of artificial intelligence systems in the field of accounting with the guidance of corporate management sufficient attention to the application of intelligence systems Artificial with improved quality of accounting curricula and learning programs in universities.

Progesterone (P4) is a well-known steroid hormone that plays a key role in oocyte growth and the maintenance of pregnancy in mammals, including cattle. Heat stress (HS) has an adverse effect on P4 synthesis through an imbalance in the cellular redox status. We have recently revealed that a standardized extract of Asparagus officinalis stem (EAS) increases P4 through non-HS induction of heat shock protein 70 (HSP70) and a synergistic increase of HSP70 by enhancing the intracellular redox balance, which was adversely affected by HS in bovine granulosa cells (GCs). Bovine GCs collected from bovine ovarian follicles were cultured at 38.5 °C and 41 °C for 12 h with or without 5 mg/mL EAS. After treatment, cells and culture suppernatant were collected for the analysis. Enzyme-linked immunosorbent assay (ELISA) was performed to detect in P4 levels. Quantitative reverse-transcription polymerase chain reaction (RT-qPCR) was used to detect expression of steroidogenesis related genes. Fluorescence staining was used to detect mitochondrial activity and lipid droplet. P4 level was increased by EAS treatment in association with increase in steroidogenic acute regulatory protein (STAR), 3β-hydroxysteroid dehydrogenase (3β-HSD), mitochondrial membrane activity and lipid droplet both under non-HS and HS conditions. Notably, synergistic effect of EAS with HS co-treatment was observed to show a greater increase in P4 synthesis when comparison with EAS treatment under non-HS condition. Furthermore, inhibition of HSP70 significantly reduced EAS-induced P4 synthesis, mitochondrial activity and synthesis of lipid droplets. These results suggest that P4 synthesis by EAS is mediated by the steroidogenesis pathway via HSP70-regulated activation of STAR and 3β-HSD, together with improved mitochondrial activity and lipid metabolism in bovine GCs. Moreover, effect of EAS has a synergistic effect of with HSP70-regulated steroidogenesis pathway.

An alternative measure of uncertainty related to residual lifetime function is the dynamic cumulative residual entropy which plays a significant role in reliability and survival analysis. This article deals with estimating dynamic cumulative residual Renyi entropy (DCRRE) for Lomax distribution using maximum likelihood and Bayesian methods of estimation. The maximum likelihood estimates and approximate confidence intervals of DCRRE are derived. Bayesian estimates and Bayesian credible intervals are derived based on gamma priors for the DCRRE under squared error, linear exponential (LINEX) and precautionary loss functions. The Metropolis-Hastings algorithm is employed to generate Markov chain Monte Carlo samples from the posterior distributions. The Bayes estimates are compared through Monte Carlo simulations. Regarding simulation results, we observe that the maximum likelihood and Bayesian estimates of the DCRRE are decreasing function on time. Further, maximum likelihood and Bayesian estimates of the DCRRE perform well as the sample size increases. Bayesian estimate of the DCRRE under LINEX loss function is more convenient than the other estimates in the most of the situations. Real data set is analyzed for clarifying purposes.

Dynamic cumulative residual entropy is a recent measure of uncertainty which plays a substantial role in reliability and survival studies. This article comes up with Bayesian estimation of the dynamic cumulative residual entropy of Pareto Ⅱ distribution in case of non-informative and informative priors. The Bayesian estimator and the corresponding credible interval are obtained under squared error, linear exponential (LINEX) and precautionary loss functions. The Metropolis-Hastings algorithm is employed to generate Markov chain Monte Carlo samples from the posterior distribution. A simulation study is done to implement and compare the accuracy of considered estimates in terms of their relative absolute bias, estimated risk and the width of credible intervals. Regarding the outputs of simulation study, Bayesian estimate of dynamic cumulative residual entropy under LINEX loss function is preferable than the other estimates in most of situations. Further, the estimated risks of dynamic cumulative residual entropy decrease as the value of estimated entropy decreases. Eventually, inferential procedure developed in this paper is illustrated via a real data.

Introduction: Children suffering from Iron Deficiency Anemia (IDA) have shown iron-deficiency associated with psychomotor and cognitive abnormalities and impact language and learning acquisition in children. Children of two years old also demonstrate a decrease in mental investment than non-anemic children, although there is an evident improvement once treatment started. This work aims to establish baseline data about the size and distribution of language disorders among kids with iron deficiency anemia.Method: This study carried out two groups: The (study group) included 25 children diagnosed with IDA. Compared to another group (control group), had 25 not diagnosed with IDA. According to the language assessment protocol, all children were assessed: Parents interview and history, audiological evaluation, Psychometric evaluation, Arabic Preschool Language Scale-4 "APLS-4 test, Mansoura Arabic Articulatory Test, Complete blood count (CBC), Serum iron and ferritin test.Results: A statistically significant difference between the study and the control group regarding the (receptive, expressive, and total) row scores. There was a positive fair significant correlation between the receptive and expressive language score and serum iron.Conclusion: There is evidence that children with Iron Deficiency Anemia show more deficient language development than normal children.

Background /Aims: Stuttering typically emerges in the preschool years as children are experiencing substantial growth in their language and are beginning to combine words to form short sentences. Stuttering occurs during the process of planning utterances and using sounds to create words and sentences. A significant percentage of stutterers had a history of delayed language development and articulation disorders. This study's purpose was to examine differences between children who stutter (CWS) and child who do not stutter (CWNS) on standardized tests of IQ, language test, and articulatory tests.Patients and Methods: An analytic cross sectional study conducted on two groups of subjects. The study group consisted of 52 children (study group) who stutter (CWS) and control group included 52 children who do not stutter (CWNS). Each child in the study group was audio-recorded, which was subsequently assessed by (Arabic version of stuttering severity index "A-SSI") to provide information pertinent to the child's frequency and type of speech dysfluencies. Each child was determined and responded to standardized tests of cognitive, language, and articulatory assessment.Results: There was a significant decrease in receptive, expressive, and total language scores of language test within cases; regards to articulation test, there was a considerable increase of SSDs. These differences in receptive/expressive language and total language scores were significantly correlated with the overall stuttering frequency of cases CWS.Conclusion: Findings were taken to suggest the imbalance among components of the speech-language systems of CWS that may contribute to the difficulties they have establishing usual speech fluency.

Background Teachers are more likely to develop voice disorders compared to non-teachers in other occupations. Teachers are often cited as a high-risk group for vocal dysfunction as they use their voices extensively over their profession for instructing and managing students, also due to other extra loading factors, such as background noise, long speaking distance, poor room acoustics, and lack of adequate equipment, like voice amplifiers. The primary school teachers are particularly at risk as they have little opportunity for voice rest during the working day. Gender is another factor affecting incidence of voice disorders. Female teachers seem to be more affected by voice disorders than male teachers. The aim of our study was to compare between genders (male–female teachers) in primary schools to show the effect of teaching and other risk factors on their voice for proper management. Results The study showed that there were statistically significant differences between male teachers and female teachers regarding history of voice change; female teachers had history of voice change more than male teachers. Female teachers suffered from emotional stress more than male teachers, and this affects their voice. In addition, study showed a significant association between the grade of dysphonia and VHI. Conclusion There is evidence that female teachers are complaining more of voice change and suffering from voice disorders than males. Besides, female teachers are showing a higher degree of emotional stress. This may necessitate a combined assessment of the voice and psychological profile of all teachers with voice change.

The use of Fair Value in financial reporting has developed a debate about the impact of fair value accounting on Earning Quality. FVA is a market-based measurement. Nevertheless, Fair Value is considered unreliable and often it is subject to managerial discretion, especially when markets are illiquid or inactive. Fair value is based on subjectivity in estimation that allows management opportunities for the exercise of judgments and intentional bias as a result the quality of financial reporting decrease and negatively affects stakeholders’ decisions. Management discretion can result in a higher earning quality and in a reduced amount of earning quality.

Effects of temperature on the development, survival, reproduction, longevity and sex ratio of the cotton mealybug, Phenacoccus solenopsis Tinsley, was assessed at five constant temperatures ranging from 20 to 35°C and five fluctuating temperatures ranging from 15 to 40°C under laboratory conditions. Results showed that nymphal development duration, preoviposition period, oviposition period, fecundity, and adult longevity were reduced significantly with increasing temperature until 30°C, but developmental duration of third female nymphal instar and female adult longevity was longer at 35°C than 30°C, and no males could emerge from pupae at the constant temperature 35°C. Fluctuating temperature, in general, significantly accelerated the nymphal developmental duration, prolonged preoviposition period, shortened oviposition period, reduced fecundity, lowered the survival rate of nymphs, and decreased adult longevity of males and females compared to their mean corresponding constant temperature. Overall, it is suggested that one should be prudent when applying the obtained results under constant and fluctuating temperatures under laboratory conditions.

Entropy is a measure of uncertainty in a random variable which quantifies the expected value of the information contained in that random variable. This article estimates the Shannon entropy of the inverse Weibull distribution in case of multiple censored data. The maximum likelihood estimator and the approximate confidence interval are derived. Simulation studies are performed to investigate the performance of the estimates at different sample sizes. Real data are analysed for illustration purposes. In general, based on the outcomes of study we reveal that the mean square errors values decrease as the sample size increases. The maximum likelihood of entropy estimates approaches the true value as the censoring level decreases. The intervals of the entropy estimates appear to be narrow as the sample size increases with high probability.

Background: Physiotherapy plays an important role in Pediatric Intensive Care Unit (PICU) after cardiac surgery, and addition of manual hyperinflation (MHI) to physiotherapy program may help early weaning from mechanical ventilation and decrease length of stay in PICU. Objective: To measure the effect of MHI on ventilation period and ICU stay days in pediatric post cardiac surgery patients. Patients and methods: Thirty patients from both sexes were selected from PICU at Academic Institute for Heart Surgery, Ain Shams University. Their ages ranged from 6 to 36 months. Results: There was a significant decrease in PaCO2 post treatment compared with that pre-treatment in the study and control groups (p>0.05). There was a significant increase in PaO2 post treatment compared with that pre-treatment in the study and control groups (p>0.001). Comparison between groups post treatment revealed a significant increase in PaO2 and a significant decrease in PaCO2 of the study group compared with that of the control group (p>0.01). There was a significant decrease in ventilation days and ICU stay days of the study group. Conclusion: Based on this study, it could be concluded that manual hyperinflation improves arterial oxygenation and reduces length of stay in PICU.

Background A majority of extremely preterm infants are treated with mechanical ventilation, which is associated with an increased risk for future development of chronic lung disease, neonatal brain damage, and neurodevelopmental impairments. Objectives The aim of the current study was to evaluate the current and follow up neurodevelopmental status of an Egyptian sample of newly and previously discharged mechanically ventilated infants following them up for a period of 6 months for the earlier group and a year for the latter. Patients and Methods The current study was designed to be a descriptive study with retrospective (50 infants) and prospective (50 infants) domains. It was carried out on 100 neonates who were recruited from the Pediatric Neonatology Clinic, Children's Hospital and Neonatal Intensive Care Unit, Ain Shams University using clinical evaluation, Bayley Scales of Infant Development, and Childhood Autism Rating Scale (CARS).. Results There was statistically significant negative correlation between CARS score and Bayley Scale by using Composite Score (Cognitive, Language and Motor) on first assessment and follow up in the Prospective group while no correlation was found in the retrospective group. The study results showed that there was no statistical significant difference between two groups as regards gestational age, gender, residency, consanguinity, maternal disease, maturity, mode of delivery, respiratory distress, duration of stay in NICU, duration on mechanical ventilation, weight on admission, audiometry and fundus examination (P > 0.05). Conclusion Using a mechanical ventilator in the neonatal period for a prolonged duration increased the risk for ASD and neurodevelopmental delay. Future studies on large samples are recommended from multicenters to confirm the validity of such findings, Bayley scale is a predicative for neurodevelopmental delay in neonates with long duration stay at NICU especially preterms with low birth weight.

Dynamic cumulative residual (DCR) entropy is a valuable randomness metric that may be used in survival analysis. The Bayesian estimator of the DCR Rényi entropy (DCRRéE) for the Lindley distribution using the gamma prior is discussed in this article. Using a number of selective loss functions, the Bayesian estimator and the Bayesian credible interval are calculated. In order to compare the theoretical results, a Monte Carlo simulation experiment is proposed. Generally, we note that for a small true value of the DCRRéE, the Bayesian estimates under the linear exponential loss function are favorable compared to the others based on this simulation study. Furthermore, for large true values of the DCRRéE, the Bayesian estimate under the precautionary loss function is more suitable than the others. The Bayesian estimates of the DCRRéE work well when increasing the sample size. Real-world data is evaluated for further clarification, allowing the theoretical results to be validated.

Leadless pacing (LP) is a rapidly evolving technology for the treatment of bradyarrhythmia that avoids lead and device pocket-related complications of traditional transvenous pacemakers. As leadless pacemakers are placed with increased frequency, more patients will present to the operating theatre with these devices in place. With the increase in the complexity of LP technology, an evolving challenge for the anesthesiologist develops as current perioperative guidelines do not address management of LPs. Herein we present a case in which the complexity of an advanced LP technology contributed to hemodynamic instability encountered in a patient undergoing off pump coronary artery bypass grafting. Lessons learned from this report will add to the limited existing body of knowledge regarding perioperative management of leadless pacemakers in the cardiac surgical patient.

Background: Pulmonary arterial hypertension (PAH) is a progressive proliferative vasculopathy associated with mechanical and electrical changes, culminating in increased vascular resistance, right ventricular (RV) failure, and death. With a main focus on invasive tools, there has been an underutilization of echocardiography, electrocardiography, and biomarkers to non-invasively assess the changes in myocardial and pulmonary vascular structure and function during the course of PAH.Methods: A SU5416-hypoxia rat model was used for inducing PAH. Biventricular functions were measured using transthoracic two-dimensional (2D) echocardiography/Doppler (echo/Doppler) at disease onset (0 week), during progression (3 weeks), and establishment (5 weeks). Similarly, electrocardiography was performed at 0, 3, and 5 weeks. Invasive hemodynamic measurements and markers of cardiac injury in plasma were assessed at 0, 3, and 5 weeks.Results: Increased RV systolic pressure (RVSP) and rate of isovolumic pressure rise and decline were observed at 0, 3, and 5 weeks in PAH animals. EKG showed a steady increase in QT-interval with progression of PAH, whereas P-wave height and RS width were increased only during the initial stages of PAH progression. Echocardiographic markers of PAH progression and severity were also identified. Three echocardiographic patterns were observed: a steady pattern (0–5 weeks) in which echo parameter changed progressively with severity [inferior vena cava (IVC) expiratory diameter and pulmonary artery acceleration time (PAAT)], an early pattern (0–3 weeks) where there is an early change in parameters [RV fractional area change (RV-FAC), transmitral flow, left ventricle (LV) output, estimated mean PA pressure, RV performance index, and LV systolic eccentricity index], and a late pattern (3–5 weeks) in which there is only a late rise at advanced stages of PAH (LV diastolic eccentricity index). RVSP correlated with PAAT, PAAT/PA ejection times, IVC diameters, RV-FAC, tricuspid systolic excursion, LV systolic eccentricity and output, and transmitral flow. Plasma myosin light chain (Myl-3) and cardiac troponin I (cTnI) increased progressively across the three time points. Cardiac troponin T (cTnT) and fatty acid-binding protein-3 (FABP-3) were significantly elevated only at the 5-week time point.Conclusion: Distinct electrocardiographic and echocardiographic patterns along with plasma biomarkers were identified as useful non-invasive tools for monitoring PAH progression.

More than 2 billions of the world’s population are children and adolescents (one third of the total). Low and middle income countries are the source of 90% of them where they represent about 50% of their population

Acute kidney injury (AKI) is a serious condition that affects critically ill patients admitted to the ICU. In this study, we report the association between right ventricle shape and AKI in a cohort of burn and trauma patients. This study is a retrospective review of trauma and burn patients who were admitted to our ICU between 2013 and 2016 who underwent hemodynamic transesophageal echocardiography. Left ventricular eccentricity index (LVEI) measurements were performed on still images obtained from transgastric short-axis view clips at end diastole. LVEI was used as a surrogate of right ventricular volume loading. There were 132 patients, the mean age was 50.8 years, and they were predominantly white and males. Using logistic regression and adjusting for age, race, gender, injury mechanism, and injury severity, higher LVEI was independently significantly associated with lower incidence of AKI (odds ratio 0.03, confidence interval 0.00–0.69). Higher LVEI is associated with a lower incidence of AKI in critically injured trauma and burn patients.

Acetamiprid and imidacloprid are two important neonicotinoid insecticides that are widely utilized under field conditions for the management of sucking insect pests, including the solenopsis mealybug Phenacoccus solenopsis Tinsley (Hemiptera: Pseudococcidae). Although some information is available regarding their lethal effects, nothing is currently known about the sublethal effects of these insecticides. We, therefore, performed a series of experiments to test the lethal and sublethal effects of these chemicals on oviposition duration and fecundity. We also assessed sublethal effects on feeding behavior using the electrical penetration graph (EPG) technique. The results of this study reveal that acetamiprid toxicity is higher than imidacloprid and that both insecticides have negative effects on the oviposition, fecundity, and feeding behavior of P. solenopsis when applied at sublethal dosages. These chemicals also significantly reduce oviposition duration and fecundity and significantly prolong nonprobing duration, increase penetration problems, and reduce phloem and xylem feeding activities when compared with adults exposed to just water. No significant differences were detected in all waveform durations and events when adults previously exposed to foliage treated with each of these two insecticides were compared. The results of this study, therefore, suggest that both insecticides are capable of protecting crops from mealybug damage by not only killing these pests directly but also reducing their fecundity and inhibiting feeding behaviors when applied at sublethal dosages.

Halogens are widely used, highly toxic chemicals that pose a potential threat to humans because of their abundance. Halogens such as bromine (Br2) cause severe pulmonary and systemic injuries; however, the mechanisms of their toxicity are largely unknown. Here, we demonstrated that Br2 and reactive brominated species produced in the lung and released in blood reach the heart and cause acute cardiac ultrastructural damage and dysfunction in rats. Br2-induced cardiac damage was demonstrated by acute (3–24 h) increases in circulating troponin I, heart-type fatty acid-binding protein, and NH2-terminal pro-brain natriuretic peptide. Transmission electron microscopy demonstrated acute (3–24 h) cardiac contraction band necrosis, disruption of z-disks, and mitochondrial swelling and disorganization. Echocardiography and hemodynamic analysis revealed left ventricular (LV) systolic and diastolic dysfunction at 7 days. Plasma and LV tissue had increased levels of brominated fatty acids. 2-Bromohexadecanal (Br-HDA) injected into the LV cavity of a normal rat caused acute LV enlargement with extensive disruption of the sarcomeric architecture and mitochondrial damage. There was extensive infiltration of neutrophils and increased myeloperoxidase levels in the hearts of Br2- or Br2 reactant-exposed rats. Increased bromination of sarco(endo)plasmic reticulum Ca2+-ATPase (SERCA) and increased phosphalamban after Br2 inhalation decreased cardiac SERCA activity by 70%. SERCA inactivation was accompanied by increased Ca2+-sensitive LV calpain activity. The calpain-specific inhibitor MDL28170 administered within 1 h after exposure significantly decreased calpain activity and acute mortality. Bromine inhalation and formation of reactive brominated species caused acute cardiac injury and myocardial damage that can lead to heart failure. NEW & NOTEWORTHY The present study defines left ventricular systolic and diastolic dysfunction due to cardiac injury after bromine (Br2) inhalation. A calpain-dependent mechanism was identified as a potential mediator of cardiac ultrastructure damage. This study not only highlights the importance of monitoring acute cardiac symptoms in victims of Br2 exposure but also defines calpains as a potential target to treat Br2-induced toxicity.

A BSTRACT Background: ADHD is a neuro-behavioral disorder that is typically manifested during childhood and often persists into adulthood, it is a complex disorder influenced by many genes, genetic and environmental risk factors co-occurring in a non-random fashion. The MTHFR gene C677T polymorphism affects both nucleotide synthesis and DNA methylation, and is associated with reduced folate bioavailability and folate metabolites. Objectives: To assess the relationship between Methylenetetrahydrofolate Reductase (MTHFR) gene polymorphisms (C667T) allele and Attention Deficit Hyperactivity Disorder (ADHD) in a sample of Egyptian children. Methodology: Out of 402 reviewed patients regularly attending the Psychiatric clinic, Faculty of Postgraduate Studies for Childhood - Ain Shams University, Cairo, Egypt. According to criteria of inclusion and exclusion a sample of 30 ADHD children were enrolled in this study. The patients were selected by simple random sample during the period from January to August, 2015 with age ranged from 6- to 12-year old. A matching number of 30 healthy children with normal developmental and psychiatric evaluation, of comparable age and sex, were randomly recruited as a study control. MTHFR gene polymorphism (C677T) allele was investigated in the selected sample. Results: There was heterozygous advantage (Heterosis) regarding C677T allele genotype, a statistically significant association was found in control group compared to ADHD cases (p=0.0159). The ADHD group revealed statistically significant family history of medical illness (10%) and psychiatric illness (8.33%) (p=0.0248) compared to control group. Conclusions: The study found no association between ADHD phenotype and the MTHFR C677T gene polymorphism in Egyptian children with attention deficit hyperactivity disorder. There was positive link between ADHD and family history of medical and psychiatric illness. Keywords: MTHFR gene, C677T allele, genotype, phenotype, attention deficit hyperactivity disorder (ADHD). دراسه تأثير تعدد الأشکال الجينية للميثيلين تتراهيدروفولات المختزل في الأطفال ذوي اضطراب نقص الانتباه و فرط النشاط مستخلص: الخلفية العلمية: اضطراب فرط الحرکة ونقص الانتباه هو اضطراب سلوکي عصبي يظهر عادة أثناء الطفولة وغالبا ما يستمر إلى مرحلة البلوغ ، وهو اضطراب معقد يتأثر بالعديد من الجينات وکذلک عوامل الخطر الجينية والبيئية و التي غالبا تحدث بطريقة غير عشوائية. يؤثر تعدد أشکال الجين ميثيلين تيتراهيدروفولات للأليل C677T على تخليق کل من النوکليوتيدات ومثيلته من الحمض النووي و کذلک يرتبط بتقلص الحيوية في حمض الفوليک ومستقلبات الفولات. الأهداف: کان الغرض من هذه الدراسه هو تقييم العلاقة بين تعدد الأشکال الجيني (MTHFR) للميثيلين تيتراهيدروفولات (MTHFR) (C667T) و اضطراب فرط الحرکه وتشتت الانتباه (ADHD) في عينة من الأطفال المصريين. المنهجيه: تم فحص 402 من المرضى الذين کانوا يحضرون بانتظام عيادة الأمراض النفسية ، کلية الدراسات العليا للطفولة - جامعة عين شمس ، القاهرة ، مصر ، وفقا لمعايير الإدراج والاستبعاد قد تم تسجيل عينة من 30 طفلا من المصابين بحالات اضطراب فرط الحرکه و تشتت الانتباه في هذه الدراسة. تم اختيار المرضى بعينة عشوائية بسيطة خلال الفترة من يناير إلى أغسطس 2015 وکانت تتراوح اعمارهم بين 6 و 12 عاما. تم تسجيل عدد مماثل من 30 طفل بصحة جيدة و قد تم تقييم النمو الطبيعي والنفسي لديهم وهم في نفس العمر والجنس مقارنه بالحالات کمجموعه تحکم . تم الفحص و الأختبار للتحقق من تعدد أشکال الجين ميثيلين تيتراهيدروفولات للأليل C677T في العينة المحددة و عينه التحکم. النتائج: کانت هناک ميزة متغايرة (Heterosis) بخصوص النمط الوراثي للأليل C677T ، حيث قد وجد ارتباط ذو دلالة إحصائية في مجموعة التحکم مقارنة بحالات اضطراب فرط الحرکه و تشتت الانتباه ((P = 0.0159. کشفت مجموعة حالات فرط الحرکه و تشتت الانتباه عن تاريخ عائلي ذو دلالة إحصائية للأمراض الطبيه بنسبه 10% و کذلک الأمراض النفسية بنسبه 8.33 % (P = 0.0248) مقارنة مع مجموعة التحکم. الاستنتاجات: أظهرت الدراسة أنه لا يوجد ارتباط بين تعدد الأشکال الجيني للميثيلين تيتراهيدروفولات للأليل حالات فرط الحرکه و تشتت الانتباه في الاطفال المصريين محل الدراسه. وC677T الکلمات الدالة: اضطراب فرط الحرکة وتشتت الانتباه، النمط الظاهري، النمط الجيني، الجين ميثيلين تيتراهيدروفولات، الأليل

Summary Introduction Rhinoscleroma (RS) is a chronic granulomatous disease of URT caused by Klebsiella Rinoescleromatis. RS is considered endemic in Egypt. The nasal mucosa represents the primary region of occurrence. The disease can potentially spread to involve the larynx and trachea causing dysphonia, stridor, and airway obstruction. Objectives To describe various nasal and laryngeal presentations of RS in our endemic area, to correlate between these findings and to alert physicians to suspect RS in any case of unexplained nasal or laryngeal lesion. Methods The study included 100 patients admitted in our otorhinolaryngolgy department (Minia University, Minia, Egypt). Patients presented with various manifestations of Rhino-pharyngo-laryngo scleroma. Diagnosis based on clinical, bacteriological, and pathological examination. Results Patients had typical nasal stages of RS, however; only 12 % of patients had the typical described laryngeal presentations (ie, subglottic narrowing and subglottic membrane). Other patients presented with atypical laryngeal presentations (eg, unhealthy vocal folds, ventricular fold hypertrophy, and suproglottic sticky greenish discharge). There was significant correlation between nasal stages and laryngeal lesions. Conclusion RS can present with atypical laryngeal presentations in endemic areas which should be kept in mind to avoid misdiagnosis. Possible laryngeal lesions of RS can be predicted from observing associated nasal lesions.

The purpose was to examine the effects of an acute bout of upper body SMR with Foam Rolling as a new method for SMR or from dynamic stretch (DS), on shoulder range of motion (ROM), throwing velocity and throwing accuracy. Also to examine correlations between shoulder ROM and throwing velocity/accuracy and between playing experience (PE) and changes in throwing velocity/accuracy and ROM.20 elite female handball players (age 20 ± 5 years, weight 84 ± 9 kg) were included in the study. The study had an experimental cross-over design in which participants first performed baseline measures. They also performed SMR and DS in two different trialsCONCLUSION: An acute bout of upper body SMR does not affect ROM and does not improve throwing velocity or throwing accuracy compared to baseline or DS among elite male handball players. Nor could any correlation between ROM and throwing velocity or throwing accuracy be observed. The associations between PE and throwing performance was inconclusive. Further studies is needed to define if PE should be taken into consideration when using SMR or DS in order to improve throwing performance.

Background Low cardiorespiratory fitness (CRF) and obesity are risk factors for heart failure but their associations with right ventricular (RV) systolic function and pulmonary artery systolic pressure (PASP) are not well understood. Methods and Results Participants in the CARDIA (Coronary Artery Risk Development in Young Adults) study who underwent maximal treadmill testing at baseline and had a follow‐up echocardiographic examination at year 25 were included. A subset of participants had repeat CRF and body mass index (BMI) assessment at year 20. The associations of baseline and changes in CRF and BMI on follow‐up (baseline to year 20) with RV systolic function parameters (tricuspid annular plane systolic excursion, RV Doppler systolic velocity of the lateral tricuspid annulus), and PASP were assessed using multivariable‐adjusted linear regression models. The study included 3433 participants. In adjusted analysis, higher baseline BMI but not CRF was significantly associated with higher PASP. Among RV systolic function parameters, higher baseline CRF and BMI were significantly associated with higher tricuspid annular plane systolic excursion and RV systolic velocity of the lateral tricuspid annulus. In the subgroup of participants with follow‐up assessment of CRF or BMI at year 20, less decline in CRF was associated with higher RV systolic velocity of the lateral tricuspid annulus and lower PASP, while greater increase in BMI was significantly associated with higher PASP in middle age. Conclusions Higher CRF in young adulthood and less decline in CRF over time are each significantly associated with better RV systolic function. Higher baseline BMI and greater age‐related increases in BMI are each significantly associated with higher PASP in middle age. These findings provide insights into possible mechanisms through which low fitness and obesity may contribute toward risk of heart failure.

Background and objective Pre-eclampsia (PEC) is associated with the release of anti-angiogenic factors that are incriminated in raising systemic and pulmonary vascular resistance (PVR). Compared to the left heart and systemic circulation, much less attention has been paid to the right heart and pulmonary circulation in patients with PEC. We used transthoracic echocardiography (TTE) to estimate pulmonary artery (PA) pressure and right ventricular (RV) function in women with PEC. Materials and methods We conducted a case-control study at a tertiary care academic center. Ten early PEC (

Mitochondrial and immune dysfunctions are often implicated in the aetiology of autism spectrum disorder (ASD). Here, we studied for the first time the relationship between ASD severity measures and mitochondrial respiratory rates in freshly isolated platelets as well as the activity of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX) in isolated neutrophils. We also verified the impact of hyperbaric oxygen therapy (HBOT) on mitochondrial and immune functions as well as on ASD severity measures. Blood samples were collected from three age-matched male groups (Control (Norm-N), autistic (Aut-N), and autistic + HBOT (Aut-H)

The global concern of increasing number of children presenting with multisystem inflammatory syndrome in children (MIS-C) related to the coronavirus disease (COVID-19) has escalated the need for a case-oriented clinical approach that provides timely diagnosis and management. The aim of this study is to share our experience in managing 64 MIS-C patients of North African ethnicity guided by a risk-based algorithm. Sixty-four patients met the inclusion criteria, 19 (30%) patients were categorized as mild and moderate risk groups and cared for in an isolation ward and 45 patients who belonged to the high-risk group (70%) were admitted to the pediatric intensive care unit (PICU). Positive laboratory evidence of COVID-19 was found in 62 patients. Fever and dysfunction in 2 or more organs were confirmed in all cases (100%). Fifty patients (78%) presented with gastrointestinal symptoms, meanwhile only 10 patients (16%) had respiratory manifestations. Cardiac involvement was reported in 55 (86%) cases; hypotension and shock were found in 45 patients (70%) therein circulatory support and mechanical ventilations were needed for 45 and 13 patients respectively. Intravenous immunoglobulins (IVIG) were used for all cases and methylprednisolone was used in 60 patients (94%). Fifty-eight (91%) patients were discharged home after an average of 9 days of hospitalization. The mortality rate was 9% (6 patients). Conclusion. A single Egyptian center experience in the management of MIS-C patients guided by a proposed bed side algorithm is described. The algorithm proved to be a helpful tool for first-line responders, and helped initiate early treatment with IVIG.

Left untreated or medically managed, symptomatic severe aortic valvular disease is associated with high mortality. Whereas surgical management has tremendously reduced the mortality from aortic valve disease, it carries its own risk particularly in patients who are poor surgical candidates due to multiple comorbidities. To reduce this risk, transcatheter aortic valve replacement (TAVR) has evolved as a noninvasive alternative for treating patients with severe aortic valvular disease. With the advancement of technology and experience, the use of TAVR has expanded to encompass patients with moderate and low surgical risk, pending long-term outcome studies. This chapter discusses the conduct, complications, and care after TAVR.

Minimally invasive cardiac surgery (MICS) has evolved as a less invasive alternative for conventional cardiac surgery that utilizes full median sternotomy. Currently employed procedures that utilize the minimally invasive approach encompass mitral valve surgery, aortic valve surgery, and less commonly coronary artery bypass and right atrial surgery. MICS has fulfilled its promise of fast-tracking and reducing some perioperative morbidities compared with conventional approaches. Adequate patient selection, surgical experience in the techniques, preparedness for conversion to full sternotomy, and, above all, adequate communication between surgeons and anesthesiologists are key to the safe conduct of MICS. Future studies should focus on comparing outcomes between MICS and the recently validated percutaneous valve surgery. Longer-term outcomes of both techniques are crucial for optimal patient selection of either technique.

Background: There are psychological aspects of all voices. Thus voice disorders may be of psychogenic background. All voice disorders can have a psychological element whether as a result or as a cause. It is uncertain whether personality and psychological problems lead to particular voice disorder, or that voice disorder contributes to psychological problems and personality effects. Aims/Objectives: to determine the psychological correlates of non-organic (functional) voice disorders and MAPLs.Material and Methods: (study group) consisted of 100 patients with a change of voice and not diagnosed with any previous psychological disorder. They was compared to another group (control group) which included 50 individuals with no change of voice. Each individual of both groups were subjected to full voice evaluation protocol, The Voice Handicap index and psychological evaluation with (Eysenck Personality Questionnaire, Symptom Chick List 90-Revised and Toronto Alexithymia Scale-20)Results: the psychological problems plays a role in the dynamics of the voice problems. The recognition of such psychological effects may contribute to more adequate diagnosis and therapy of patients with persisting voice.Conclusions and Significance: the personality and psychological domains may be part of the clinical profile for a subset of patients with non-organic voice disorders and MAPLS.

An analytical method was developed to simultaneously determine pyridate, quizalofop-ethyl, and cyhalofop-butyl in brown rice, soybean, potato, pepper, and mandarin using LC-MS/MS. Purification was optimized using various sorbents: primary–secondary amine, octadecyl (C18) silica gel, graphitized carbon black, zirconium dioxide-modified silica particles, zirconium dioxide-modified silica particles (Z-SEP), and multi-walled carbon nanotubes (MWCNTs). Three versions of QuECHERS methods were then tested using the optimal purification agent. Finally, samples were extracted using acetonitrile and QuEChERS EN salts and purified using the Z-SEP sorbent. A six-point matrix-matched external calibration curve was constructed for the analytes. Good linearity was achieved with a determination coefficient ≥0.999. The limits of detection and quantification were 0.0075 mg/kg and 0.01 mg/kg, respectively. The method was validated after fortifying the target standards to the blank matrices at three concentration levels with five replicates for each concentration. The average recovery was within an acceptable range (70–120%), with a relative standard deviation

BackgroundChronic kidney failure is an irreversible medical condition that impairs the kidney’s ability to function. When CRF reaches a sophisticated stage, dangerous levels of fluid, electrolytes, and wastes can accumulate within the body. Dysphonia detected within the CRF patients was due to affection of the chronic kidney failure on the system and phonatory system. Patients with CRF treated by hemodialysis are exposed to continuous pulmonary insults of multifactorial origin: Fluid retention predisposes them to pulmonary edema which occurs more frequently within the presence of concomitant cardiovascular disease. Also, the spirit of the kidney failure patients can induce psychogenic dysphonia. The aim of this work is to see and analyzed voice problems in patients with chronic kidney failure to ascertain baseline data about the scale and distribution of the probable voice disorder in these patients for early detection and proper management.ResultsThe results obtained from this study showed that there have been statistically significant differences between chronic kidney failure patients G1 and control G2 regarding first harmonic, jitter %, shimmer dB and noise harmonic ratio dB, presence of dysphonia, and also the total score of VHI. The results of the study revealed statistical correlation between the quantity of years of hemodialysis and total acoustic measures.ConclusionThe results of our study revealed that subjects with chronic failure exhibit a clinical evidence of voice disorders and proving that there is interplay of different body systems and the larynx. The voice problems can vary between CRF patients depending on duration of hemodialysis and leading causes of chronic kidney failure.

Objectives Renal hypoperfusion is a common mechanism of cardiac surgery–related acute kidney injury (CS-AKI). However, the optimal amount of volume resuscitation to correct systemic hypoperfusion and prevent the postoperative development of CS-AKI has been a subject of debate. The goal of this study was to assess the association of volume responsiveness determined by stroke volume variation using the passive leg raise test (PLRT) at chest closure, with the development of CS-AKI according to the Kidney Disease Improving Global Outcomes criteria. Design Single-center, prospective observational study. Setting Tertiary hospital. Interventions None. Measurements and Main Results A total of 131 patients were studied from January 2015 until May 2017. All patients underwent cardiac surgery that required cardiopulmonary bypass. Volume responsiveness was assessed at chest closure using the PRLT. Stroke volume variation from the sitting to the recumbent positions was measured by transesophageal echocardiography. Fluid responsiveness was defined as an increase of >12% of stroke volume from sitting to recumbent positions. A total of 82 (68.3%) patients were fluid-responsive versus 38 (31.6%) who were fluid-unresponsive. CS-AKI occurred in 30% of patients. There was no difference in CS-AKI between fluid-responsive and fluid-nonresponsive groups. However, CS-AKI was associated independently with an increases in body mass index and preoperative diastolic blood pressure. CS-AKI also was associated with prolonged intensive care unit length of stay. Conclusion End-of-procedure volume responsiveness is not associated with a high risk for postoperative CS-AKI.

Postoperative acute kidney injury (AKI) may complicate both open and endovascular aortic aneurysm repair (EVAR) and is associated with substantial morbidity, mortality, and health care expense. We aim to evaluate the incidence of postoperative AKI and factors associated with its occurrence and the effects of postoperative AKI on long-term renal function and mortality after open and EVAR in the Society for Vascular Surgery Vascular Quality Initiative registry.Elective aneurysm cases were identified including thoracic endovascular aortic aneurysm repair (TEVAR) and complex endovascular aortic aneurysm repair (cEVAR), infrarenal endovascular repair (EVAR) and infrarenal open repair (OAR) from 2003 to 2019. The preoperative estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease formula and stratified based on chronic kidney disease (CKD) grades. Postoperative AKI was defined per the Vascular Quality Initiative definition as a creatinine increase of 0.5 mg/dL or if postoperative dialysis was required. Patients on preprocedural hemodialysis and those with previous renal transplant were excluded. Demographics and procedural factors were evaluated for predicting in-hospital postoperative AKI (all approaches) and at 9 to 21 months of long-term follow-up (EVAR only) using logistic regression modeling.We identified a total of 2813 cEVAR, 2995 TEVAR, 39,945 EVAR, and 8143 OAR patients. Of those, postoperative AKI occurred in 377 cEVAR (13.5%), 199 TEVAR (6.7%), 1099 EVAR (2.8%), and 1249 OAR (15.5%). Risk factors for postoperative AKI across all groups were worse preoperative eGFR, total number of blood transfusions, perioperative anemia, reinterventions, and postoperative respiratory complications. Additional procedure-specific risk factors of postoperative AKI were preoperative hemoglobin of less than 10 and contrast volume of 125 to 150 mL, hypertension, a low ejection fraction, and a history of percutaneous revascularization for EVAR; for both EVAR/cEVAR, renal artery coverage was a risk factor, whereas for OAR, male sex, non-White race, hypertension, suprarenal aortic cross-clamp, and increased renal ischemic time were risk factors. Among 8133 EVAR patients with long-term follow-up, a decrease in kidney function occurred in 56.7% of patients with postoperative AKI vs 19.9% without postoperative AKI (P .001). The following risk factors were associated with a decrease in renal function at long-term follow-up: postoperative AKI, a preoperative eGFR of less than 90, and hypertension. A preoperative hemoglobin of greater than 12 was protective. Postoperative AKI was associated with significantly lower survival compared with no postoperative AKI across all procedures (log rank 0.001).Postoperative AKI occurs more often in patients with worse preoperative renal function, lower preoperative hemoglobin, and in open surgeries with inter-renal or suprarenal cross-clamping. Importantly, postoperative AKI is associated with increased mortality across all types of aortic repair. Given the long-term impact of postoperative AKI on outcomes for all aortic repairs and the limitations of current insensitive functional indices, there is a need to seek more sensitive indicators of decreases in early renal structural in this population.

Objectives The current study aimed to investigate the psycho-phenotypic profile of an Egyptian sample with ADHD cases. Subjects & Methods Eighty cases diagnosed as ADHD (according to the DSMV) were enrolled in the current study. They were selected sequentially from those following up in the child and adolescent clinic, children hospital, Ain shams University. Results The ages of the enrolled sample ranged between 4&12 years. Males were (86%) and Female (14%) with ratio 7:1. Consanguinity rate was (25%) while positive family history was (12%). Perinatal insult was detected in (22%). Inattentive ADHD was seen in 90% of cases while combined type in 10%. According to Conner’s parents’ scale (5%) had mild, (25%) moderate and (70%) severe ADHD symptoms. Comorbid conditions were seen as follows; Delayed language development (30%), stuttering (9%), delayed bladder control (15%), pica (2%), polyphagia (2%), sleep disorders [nightmares (4%), insomnia (9%), somnambulism (3%)], poor academic performance (95%), dyslexia (15%), dysgraphia (18%), conduct disorder (5%) and aggression (12%). Conclusion The current study delineated that there are so many phenotypic variation in Egyptian ADHD cases. This high-lightened the importance of individual assessment of such cases in order to configure the subtype, severity and identification of possible comorbidity. This enable the clinicians to individualize a treatment plan for each patient aiming at better outcome.

Introduction Chronic liver disease encompasses a wide spectrum of disorders, including infectious, metabolic, genetic, druginduced, idiopathic, structural, and autoimmune diseases. The clinical presentation and initial laboratory data in many of these diseases are similar, and a definitive diagnosis often relies on specialized laboratory investigation and histologic examinationof liver tissue. End-stage liver disease in children presents a challenging array of medical and psychosocial problems for the health care delivery team. Health-related quality of life (HRQOL) is a marker of disease severity.Influence of the liver disease, active medical and psychiatric comorbidities, and socio-demographic variables in the determination of health-related quality of life (HRQOL) measured by a generic and a liver-specific instrument in unselected patients with chronic liver disease revealed that Psychiatric comorbidity and active medical comorbidity, and not severity of the liver disease according to Child-Pugh score,determine reduced HRQOL in patients with chronic liver diseases (Häuser et al., 2004). Aim The aim of this study was to assess the influence of chronic liver discease on health-related quality of life (HRQL) of the patients. Methods This study was conducted on 32 children with chronic liver disease (17 males ; 15 females) with ages ranging from 6-14 years, following up at the Pediatric Hepatology Clinic,The Children`s Hospital, Ain Shams university. Cohorts of 15 apparently healthy children (8 males; 7 females) with ages ranging from 5-14 years were also studied as a control group. All children included in the study were subjected to thorough clinical history and examination and Assessment of Pediatric Quality of Life using PedsQLTM Inventory both Child Self Report and Parent Proxy Report.The PedsQLTM scales comprised of parallel child selfreport and parent-proxy formats. Results Statistical comparison between studied groups as regards Health Related Quality of Life assessment among parents shows that the parents` perception of qualityof life total summary score as well as physical, emotional, and school sub-scores were significantly lower among parents of CLD children compared to controls and also showed that the child perception of quality of life total summary score as well as physical, and school subscores were significantly lower among CLD children compared to controls.

Background Autism spectrum disorders (ASD) is a neurodevelopmental disorder with multifaceted etiology; with the hormonal imbalance playing an important role. Recent evidence suggests that plasma levels of Growth Hormone (GH) and ghrelin are altered in autistic children. Both hormones play a role in mucosal integrity which is crucial in immune tolerance. Ghrelin also modulates neuroinflammatory and apoptotic processes, thus both may have an impact on pathogenesis of autism. Aim To study the GH and ghrelin status in children with ASD and their relation to anthropometry and clinical phenotype. Patients and Methods This is a cross-sectional case-controlled study that included 45 children (30 males and 15 females) diagnosed with ASD compared to 30 age, sex and pubertal stage matched clinically normal controls. Psychometric evaluation including DSM 5, IQ, and CARS were done for the patients, while serum Acyl ghrelin, GH levels and anthropometric measurements were done for both the patients and controls. Results Compared to controls, patients had significantly higher weight and BMI (19.07 ± 4.56 kg versus 23.66 ± 11.44 kg, p 0.004) and (16.20 ± 0.89 kg/m2versus 17.94 ± 4.22 kg/m2, p 0.003) respectively. Ghrelin levels were significantly lower in our cases (7.04 ± 3.95 versus 1.90 ± 0.82, p 0.000) with significant positive correlation to the age. GH levels were also significantly lower in our cases (5.86 ± 2.21 versus 2.99 ± 1.51, p 0.000) with significant negative correlation to their CARS score. Conclusion Children with ASD have lower levels of ghrelin, GH compared to their normal counterparts. These findings support the hypothesis that hormones may modulate pathogenesis of autism, thus may play a key role in diagnosis and treatment response.

Current data-centric workloads, such as deep learning, expose the memory-access inefficiencies of current computing systems. Monolithic 3D integration can overcome this limitation by leveraging fine-grained and dense vertical connectivity to enable massively-concurrent accesses between compute and memory units. Thin-Film Transistors (TFTs) and Resistive RAM (RRAM) naturally enable monolithic 3D integration as they are fabricated in low temperature (a crucial requirement). In this paper, we explore ZnO-based TFTs and HfO 2 -based RRAM to build a 1TFT-1R memory subsystem in the upper tiers. The TFT-based memory subsystem is stacked on top of a Si-FET bottom tier that can include compute units and SRAM. System-level simulations for various deep learning workloads show that our TFT-based monolithic 3D system achieves up to 11.4× system-level energy-delay product benefits compared to 2D baseline with off-chip DRAM—5.8× benefits over interposer-based 2.5D integration and 1.25× over 3D stacking of RRAM on silicon using through-silicon vias. These gains are achieved despite the low density of TFT-based RRAM and the higher energy consumption versus 3D stacking with RRAM, due to inherent TFT limitations.

The proliferation of advanced analytics and artificial intelligence has been driven by huge volumes of data that are mostly generated at the edge. Simultaneously, there is a rising demand to perform analytics on edge platforms (i.e., near-sensor data analytics). However, conventional architectures of such platforms may not execute the targeted applications in an energy-efficient manner. Emerging near and in-memory computing paradigms can increase the energy efficiency of edge platforms by relying on emerging logic and memory devices. More importantly, these paradigms enable the possibility of performing computations on unconventional platforms, namely flexible computing systems. In this paper, we explore the benefits of in-memory computing at the edge on a flexible substrate enabled by thin-film transistors (TFTs) and resistive RAM (RRAM). As a case study, we consider bio-signal processing application workloads, i.e., compressive sensing and anomaly detection. We model the device, circuit, and architecture of our targeted platform and evaluate the corresponding system-level performance. Preliminary results indicate that in-memory computing enabled by flexible electronic devices enables a new class of edge platforms with lower power consumption, compared to that of rigid TFT devices.