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Abstract Background Quality is a primary concern of health care agencies worldwide. A conducive clinical training environment is essential for nursing students to be capable of enhancing their learning experiences and achieving the desired training outcomes. Aim This study aimed to examine the satisfaction and anxiety levels during clinical training among nursing students. Type of study A descriptive -analytical cross-sectional study design was utilized. The research was conducted at the Faculty of Nursing, Assiut University and Colleges of Applied Medical Sciences in Alnamas and Bisha, University of Bisha. Sampling method: A convenience sampling technique was used. Sample size: a sample of 1052 undergraduate nursing students. The data was gathered via a structured questionnaire including the socio-demographic characteristics and nursing students’ satisfaction with the hospital and laboratory training. Additionally, Self-Rating Anxiety Scale (SAS) was adopted to measure the anxiety level. Results The mean age of the studied sample was 21.9 ± 1.83 years, and 56.9% are females. Moreover, 90.1% & 76.4% of the nursing students were satisfied with their hospital and laboratory training. Furthermore, 61.1% & 54.8% of the students had mild levels of anxiety regarding their hospital training and laboratory training, respectively. Conclusion The undergraduate nursing students had a high level of satisfaction with their clinical training at the hospitals and laboratories. Moreover, they had mild anxiety related to hospital and laboratory clinical training. Recommendations Developing clinical orientation and training programs and improvement strategies to enhance the effectiveness of the clinical training environment. The establishment of a modern, tastefully designed, and fully stocked skill lab for the college's student training should receive more attention. Clinical relevance Through the provision of ongoing education about different method of practice, nursing was intended to shape future professional nurses who master core competencies of the profession. Organizations may benefit from developing a comprehensive strategy to achieve an effective teaching program.

Introduction: Chickpea is a legume crop that thrives in regions with semi-arid or temperate climates. Its seeds are an excellent source of proteins, carbohydrates, and minerals, especially high-quality proteins. Chickpea cultivation faces several challenges including Fusarium wilt (FW), a major fungal disease that significantly reduces productivity.Methods: In this study, a Genome-wide Association Analysis (GWAS) was conducted to identify multiple genomic loci associated with FW resistance in chickpea. We conducted a comprehensive evaluation of 180 chickpea genotypes for FW resistance across three distinct locations (Ethiopia, Tunisia, and Lebanon) during the 2-year span from 2015 to 2016. Disease infection measurements were recorded, and the wilt incidence of each genotype was calculated. We employed a set of 11,979 single nucleotide polymorphisms (SNPs) markers distributed across the entire chickpea genome for SNP genotyping. Population structure analysis was conducted to determine the genetic structure of the genotypes.Results and Discussion: The population structure unveiled that the analyzed chickpea germplasm could be categorized into four sub-populations. Notably, these sub-populations displayed diverse geographic origins. The GWAS identified 11 SNPs associated with FW resistance, dispersed across the genome. Certain SNPs were consistent across trials, while others were specific to particular environments. Chromosome CA2 harbored five SNP markers, CA5 featured two, and CA4, CA6, CA7, and CA8 each had one representative marker. Four SNPs demonstrated an association with FW resistance, consistently observed across a minimum of three distinct environments. These SNPs included SNP5826041, SNP5825086, SNP11063413, SNP5825195, which located in CaFeSOD, CaS13like, CaNTAQ1, and CaAARS genes, respectively. Further investigations were conducted to gain insights into the functions of these genes and their role in FW resistance. This progress holds promise for reducing the negative impact of the disease on chickpea production.

This paper investigates the effect of rotor flux screens (conducting screens) on the performance of switched reluctance motors with a higher number of rotor poles than stator poles. A high number of rotor poles decreases the torque ripple, which is desirable for electric vehicle applications. The conducting screens fill the rotor interpolar gaps forming a cylindrical rotor hence alleviating the windage losses, especially effective at high speeds. The effect of conducting screen thickness and material electrical conductivity on current rise time, developed torque, and output power is studied. A procedure for calculating the effective value of unaligned inductance for screened motors using the flux tube method is presented. Finite element analysis results for different screen cases confirm the effectiveness of conducting screens in improving the torque, hence power capability, of switched reluctance motors. Received: 11 January 2023 Accepted: 03 May 2023 Published: 30 May 2023

Grass pea is a promising crop with the potential to provide food and fodder, but its genomics has not been adequately explored. Identifying genes for desirable traits, such as drought tolerance and disease resistance, is critical for improving the plant. Grass pea currently lacks known R-genes, including the nucleotide-binding site-leucine-rich repeat (NBS-LRR) gene family, which plays a key role in protecting the plant from biotic and abiotic stresses. In our study, we used the recently published grass pea genome and available transcriptomic data to identify 274 NBS-LRR genes. The evolutionary relationships between the classified genes on the reported plants and LsNBS revealed that 124 genes have TNL domains, while 150 genes have CNL domains. All genes contained exons, ranging from 1 to 7. Ten conserved motifs with lengths ranging from 16 to 30 amino acids were identified. We found TIR-domain-containing genes in 132 LsNBSs, with 63 TIR-1 and 69 TIR-2, and RX-CCLike in 84 LsNBSs. We also identified several popular motifs, including P-loop, Uup, kinase-GTPase, ABC, ChvD, CDC6, Rnase_H, Smc, CDC48, and SpoVK. According to the gene enrichment analysis, the identified genes undergo several biological processes such as plant defense, innate immunity, hydrolase activity, and DNA binding. In the upstream regions, 103 transcription factors were identified that govern the transcription of nearby genes affecting the plant excretion of salicylic acid, methyl jasmonate, ethylene, and abscisic acid. According to RNA-Seq expression analysis, 85% of the encoded genes have high expression levels. Nine LsNBS genes were selected for qPCR under salt stress conditions. The majority of the genes showed upregulation at 50 and 200 μM NaCl. However, LsNBS-D18, LsNBS-D204, and LsNBS-D180 showed reduced or drastic downregulation compared to their respective expression levels, providing further insights into the potential functions of LsNBSs under salt stress conditions. They provide valuable insights into the potential functions of LsNBSs under salt stress conditions. Our findings also shed light on the evolution and classification of NBS-LRR genes in legumes, highlighting the potential of grass pea. Further research could focus on the functional analysis of these genes, and their potential use in breeding programs to improve the salinity, drought, and disease resistance of this important crop.

Background: Coronal deformities around the knee are most commonly presented in paediatric orthopaedic. Physiological deformities are most often managed conservatively, but severe deformities that cause pain and dysfunction require surgical intervention with acute correction (osteotomy), or gradually by hemiepiphyseodesis. Objectives: The main objective of this prospective study is to assess and compare short term results following correction by osteotomy versus 8-plate hemiepiphyseodesis. Patients and Methods: 30 skeletally immature patient, aged (3-14 years); presented with angular deformities, 15 patient undergone corrective osteotomy for acute correction of the deformity, 15 patients had 8 plate hemiepiphyseodesis. Results: The follow-up of both groups was every 3 months till 1 year post-operative. At 12-month follow-up, no statistically significant differences were observed between groups in radiographic parameters in patients with varus and valgus deformities (Independent sample t test, P > .05). At last follow-up, both groups showed statistically significant improvement in all radiographic parameters in patients with varus and valgus deformities (Repeated Measure ANOVA, P < .05). Conclusion: This study showed no statistically significant difference in radiographic parameters between acute correction by osteotomies , and gradual correction by guided growth at 1 year follow up.

MDD or depression is psychiatric disorder which affects many of people globally. Due to the nonexistence of any available laboratory tests, poor identification of depression is a key contributing factor. In this study, a framework is developed in order detect depression with minimal number of channels to increase the portability as well as with high accuracy. In this study, two dataset has been considered i.e. Public and Private dataset. Different regions of brain as well as feature has been selected to find out the minimal number of channels and features so that higher accuracy is also achieved. According to the study, depression has different impacts on each hemisphere of the temporal and parietal regions of the brain. Depression also has an impact on Detrended Fluctuation Analysis. The study results in a model made up of 4 channels with high accuracy of 91.74% which is portable, faster and cheaper. Thus, model can act as an assistive tool for diagnosis of depression. The study confirms that depression affects the temporal area of the brain since using the same set of features and classifiers in both the public and private datasets and utilising only temporal channel EEG data provided quite high accuracy in detection of MDD. The fact that using features delta, alpha, beta paired asymmetry and DFA from only temporal channel (T8 and T9) provided high accuracy of 89.24%(Public Dataset) and 82.68%(Private Dataset) supports the claim that the temporal lobe of the brain is impacted by depression.

This article presents a set of control enhancements for standard vector current control (VCC) that improves its stability and dynamic performance in an extended range of SCRs. Increasingly, the local SCR as seen by the converter fluctuates, making it difficult to tune the control algorithms. Usually, stability is prioritised over performance and converters become less responsive. The modifications proposed in this article allow VCC to maintain high dynamic performance and stability, optimised to the real-time grid conditions. These modifications do not alter the standard operation of the outer loops, the current controller or the phase-locked loop. Instead, a Pre-emptive Voltage Decoupler (PVD) is introduced to compensate reactive current for changes in active current, thus decoupling the local voltage from active power. The PVD is optimised to the grid conditions by an impedance estimator. Further, an instability detector is proposed, anticipating instability and triggering preventive action, improving the resiliency of the converter. Supervisory control is employed to coordinate instability detection, prevention, impedance estimation and PVD optimisation. As a result, VCC is more responsive and adaptable to variable grid conditions. It is also more resilient to grid events, such as the loss of a transmission line.

Objective: To assess the molluscicidal effect of the eco-friendly green synthesized neem silver nanoparticles (neem-Ag NPs) against Biomphalaria alexandrina, the snail intermediate host for Schistosoma mansoni, and their cercaricidal potential. Methods: Methanol extracts from neem fruits were used for green synthesis of neem-Ag NPs. The neem-Ag NPs were characterized using UV-visible absorption spectra, dynamic laser light scattering technique, and transmission electron microscopy. The potential molluscicidal effect against adult and juvenile Biomphalaria alexandrina and the effect of the sub-lethal concentration on hatching of snail eggs and Schistosoma mansoni cercariae were evaluated. Results: The surface plasmon resonance of neem-Ag NPs showed a sharp absorption peak at λmax = 518 nm together with multiple peaks. The hydrodynamic diameter was (77.15±34.53) nm, the polydispersity index (0.338±0.000) and the zeta-potential −14.07 mV. Moreover, transmission electron microscopy showed that the average size of the nanoparticles was (27±2) nm. Agglomeration was evident and a light-colored capping layer could be seen coating the nanoparticles. Juvenile snails (LC50: 0.83 ppm) were more susceptible to neem-Ag NPs than adults (LC50: 1.07 ppm). In addition, neem-Ag NPs and neem at LC50 concentrations inhibited the egg-hatching of snails and showed cercaricidal activity in a time-dependent manner. Conclusions: Neem-Ag NPs have lethal activities against Biomphalaria alexandrina snails and their eggs, as well as Schistosoma mansoni cercariae. Hence, neem-Ag NPs could be a potential agent to control schistosomiasis.

BACKGROUND: Diabetic nephropathy (DN) is a complication of chronic hyperglycemia associated with diabetes mellitus (DM). Several studies have demonstrated the positive impact of sodium-glucose cotransporter-2 (SGLT2) inhibitors on kidney outcomes. The objective of the study was to evaluate the effects of dapagliflozin, an SGLT2 inhibitor, on kidney outcomes in Saudi patients with type 2 DM. MATERIALS AND METHODS: Study included all Saudi patients with type 2 DM who visited our center from August 1, 2021, to July 31, 2022, and had been on dapagliflozin for at least 3 months. Data was abstracted through chart review for all patients included in the study. Paired t-test or Wilcoxon signed-rank test were used to compare the results before and after treatment for continuous variables and the McNemar test was used to compare the results for categorical data. RESULTS: Study included 184 Saudi patients with type 2 diabetes with a mean age of 61.32 years (SD=9.37). Dapagliflozin 10 mg/day significantly reduced hemoglobin A1C (HbA1C) from a mean (SD) of 9.00 to 8.40 (P < 0.001). Among a subgroup of patients with significant proteinuria (n = 83), dapagliflozin significantly reduced ACR from a median of 93.1 to 64.9 mg/g (P = 0.001). Following treatment, the estimated glomerular filtration rate improved from a mean of 69.83 to 71.68 mL/min and the mean arterial pressure (MAP) fell from 90.03 to 89.06 mmHg, both were not statistically significant. Despite a statistically insignificant increase in the episodes of urinary tract infections (UTIs), the hospitalization rate declined. No episodes of amputations or ketoacidosis occurred during the study period. CONCLUSION: SGLT2 inhibitors had beneficial effects among Saudi patients with type 2 diabetes by improving diabetic control and lowering proteinuria. Dapagliflozin did not result in significant harm, including UTIs, amputations, and ketoacidosis.

Pb1−4.75xNd0.5xNi4xZrO3 (where x = 0.00, 0.01, 0.02, 0.03, 0.04 and 0.05) nanocrystals were synthesized through the micro-emulsion, a wet chemical route. The prepared samples were annealed at 700°C for 3 h. Nanocrystalline samples were characterized by various techniques like XRD (X-rays diffraction), FTIR (Fourier transform infrared spectroscopy), SEM (Scanning electron microscopy), dielectric properties, and dc-electrical resistivity. XRD analysis of synthesized nanocrystals confirmed the phase development of orthorhombic perovskite structure. The average measured size of nanocrystals was about 21 nm. Some other parameters like densities (bulk and X-rays) and porosity of the nanomaterials were also calculated from obtained XRD data. The obtained results showed the effect of dopant materials (Nd3+ and Ni2+ metal ions) incorporation. The FTIR spectra elucidated the intrinsic cations vibrations in the characteristic perovskite orthorhombic structure. The SEM results revealed that nano-grains were synthesized successfully and their average observed size was 60 nm. It was observed that with the addition of dopant material, the dielectric parameters like dielectric constant, loss factor, and conductivity were showed an overall decreasing trend. The average calculated value of the ac conductivity at the frequency of 3 GHz was observed as 1.45 × 10−2 (Ω-cm)−1. By using the current–voltage (I–V) characteristics, the dc-electrical resistivity was calculated in the range between 2.68 × 1010 and 4.82 × 1010 Ω-cm. The dc-electrical resistivity was increased with the increase of doping contents.

A structure-guided modelling approach using COX-2 as a template was used to investigate the effect of replacing the chloro atom located at the chlorophenyl ring of amide-linked bipyrazole moieties, aiming at attaining better anti-inflammatory effect with a good safety profile. Bromo, fluoro, nitro, and methyl groups were revealed to be ideal candidates. Consequently, new bipyrazole derivatives were synthesised. The in vitro inhibitory COX-1/COX-2 activity of the synthesised compounds exhibited promising selectivity. The fluoro and methyl derivatives were the most active candidates. The in vivo formalin-induced paw edoema model confirmed the anti-inflammatory activity of the synthesised compounds. All the tested derivatives had a good ulcerogenic safety profile except for the methyl substituted compound. In silico molecular dynamics simulations of the fluoro and methyl poses complexed with COX-2 for 50 ns indicated stable binding to COX-2. Generally, our approach delivers a fruitful matrix for the development of further amide-linked bipyrazole anti-inflammatory candidates.

This study considers the case of unreliable equipment subjected to random failures that induce high maintenance and environmental costs. We consider situations where the equipment is located in remote areas, which are difficult to access, and situations where there could be confinement linked to a pandemic, making it impossible to perform the replacement of the failed equipment. In such situations, the objective is to explore the possibility of providing a system with self-maintenance capabilities to a certain extent by adding redundant (stand-by) identical modules. Both the designs (with and without passive redundancy) are considered. A mathematical cost model is developed for each alternative to help decide whether to adopt redundancy and determine the optimal number of redundant modules, which minimises the total expected cost. The latter includes the costs related to the acquisition, maintenance, and recycling of failed modules. A numerical example is presented, and a sensitivity study is performed to investigate the effect of variations in relevant input parameters on the optimal design.

Background: The basic helix-loop-helix (bHLH) transcription factor is a vital component in plant biology, with a significant impact on various aspects of plant growth, cell development, and physiological processes. Grass pea is a vital agricultural crop that plays a crucial role in food security. However, the lack of genomic information presents a major challenge to its improvement and development. This highlights the urgency for deeper investigation into the function of bHLH genes in grass pea to improve our understanding of this important crop.Results: The identification of bHLH genes in grass pea was performed on a genome-wide scale using genomic and transcriptomic screening. A total of 122 genes were identified as having conserved bHLH domains and were functionally and fully annotated. The LsbHLH proteins could be classified into 18 subfamilies. There were variations in intron-exon distribution, with some genes lacking introns. The cis-element and gene enrichment analyses showed that the LsbHLHs were involved in various plant functions, including response to phytohormones, flower and fruit development, and anthocyanin synthesis. A total of 28 LsbHLHs were found to have cis-elements associated with light response and endosperm expression biosynthesis. Ten conserved motifs were identified across the LsbHLH proteins. The protein-protein interaction analysis showed that all LsbHLH proteins interacted with each other, and nine of them displayed high levels of interaction. RNA-seq analysis of four Sequence Read Archive (SRA) experiments showed high expression levels of LsbHLHs across a range of environmental conditions. Seven highly expressed genes were selected for qPCR validation, and their expression patterns in response to salt stress showed that LsbHLHD4, LsbHLHD5, LsbHLHR6, LsbHLHD8, LsbHLHR14, LsbHLHR68, and LsbHLHR86 were all expressed in response to salt stress.Conclusion: The study provides an overview of the bHLH family in the grass pea genome and sheds light on the molecular mechanisms underlying the growth and evolution of this crop. The report covers the diversity in gene structure, expression patterns, and potential roles in regulating plant growth and response to environmental stress factors in grass pea. The identified candidate LsbHLHs could be utilized as a tool to enhance the resilience and adaptation of grass pea to environmental stress.

Introduction: Ventricular septal rupture (VSR) is a rare complication of ST-elevation myocardial infarction (STEMI), typically discovered post-revascularization.Case report: We present the first case of VSR detected on point-of-care ultrasound (POCUS) in the emergency department immediately prior to emergent angiography, with management positively affected by this discovery. The VSR was quickly confirmed via right heart catheterization. Subsequently, hemodynamic stability was achieved using an intra-aortic balloon pump. A delayed surgical VSR repair, with concomitant coronary artery bypass grafting, was implemented for definitive management.Conclusion: This case highlights the utility of POCUS in a STEMI patient with a suspected mechanical complication.

Hassan Khaled,1,&ast; Bilal Haj Najeeb2,&ast; 1Magrabi Eye & Ear Hospital, Makkah, Saudi Arabia; 2Department of Ophthalmology, Medical University of Vienna, Vienna, Austria&ast;These authors contributed equally to this workCorrespondence: Hassan Khaled, Magrabi Eye & Ear Hospital, The Holy Mosque Street, Al Murasalat, Makkah, 24247, Saudi Arabia, Email hassan.adel@magrabi.com.saAbstract: Leakage of fluid through the side port during aspiration of the cortex leads to instability of the anterior chamber. In addition, eye movement may cause an unintended pulling of the irrigation probe out of the corneal wound resulting in collapsing of the anterior chamber. Both situations could pose a challenge to the surgeon and increase the risk of serious intraoperative complications. Therefore, we describe a simple effective maneuver to avoid these conditions during bimanual cortex removal and viscoelastic washout. In Khaled technique, rotating the irrigation probe outwards causes complete occlusion of the lumen of the side port and a simultaneous stabilization of the anterior chamber. Twisting the incision by the irrigation probe also offers better fixation of the eye at the edge of the side port and a subsequent reduction of eye movement.Keywords: irrigation probe, irrigation/aspiration, cataract surgery, cortex removal, phacoemulsification

Background and Aim: The multivariate discriminant (MVD) analysis was a successful statistical tool with a discriminatory capacity for tracing sheep breeds based on meat characteristics. Thus, this study aimed to identify three Saudi sheep breeds based on the physical and histochemical aspects of meat using MVD analysis. Materials and Methods: Eight male lambs from each breed, Najdi, Neami, and Harri, were selected randomly at 90 days of age and allocated into three groups for breeding in a completely randomized design. The feeding and rearing management were similar for an experimental period of 90 days. The experimental diet consisted of a concentrated mixture with identical amounts of calories and nitrogen. Fifty-one meat characteristics were measured in the preliminary MVD, representing hot and cold carcass weight, meat cuts and quality measures, body component weights, fat deposit weights, and histochemical characteristics. Results: Out of the total meat characteristics measured, only 19 characteristics had significant discriminant power. The most powerful characteristics were temperature, empty intestinal weight, pH24, external carcass length, heart weight, and L1, based on partial R-square and Wilks' lambda values. The phenotypic associations between the characteristics had strong associations. The obtained principal components efficiently classified the eight individuals of each breed into distinct groups using robust discriminant characteristics. Conclusion: This method allowed us to determine the breed of sheep carcasses and cuts by considering the physical characteristics of the meat. Therefore, butchers and consumers should use scientific techniques for assigning carcasses and meat to their sheep breed after slaughtering.

Abstract In recent years the process of transportation needs a highly effective traffic system in order to monitor all consumer goods as many goods are left out at different locations. To handle such moving cases cloud platform is highly helpful as with respect to geographical location the goods are mapped in correct form. However incorporation of single cloud platform does not provide sufficient amount of storage about all goods thus a multiple cloud platform is introduced in proposed system. As multiple cloud platform is provided the security features of each data base system is also checked and enhanced using encryption keys. Moreover for proper operating conditions of multiple cloud platforms an analytical model is designed that synchronizes necessary data at end system. The defined analytical model focuses on solving multiple objectives that are related to critical energy problems where demand problems are reduced. Further the encryption process is carried out using Improved BlowFish Algorithm (IBFA) by allocating proper resources with decryption keys. To validate the effectiveness of proposed method five scenarios are considered where all scenario outcomes proves to be much higher than existing models by an average of 43%.

Lane detection on roads is essential for autonomous vehicles. Most previous studies detected the area of the road and all possible lanes built on it, whereas only the specific lane that the car is currently traveling on should be detected. In addition, they are complex, slow, fail under degraded road conditions, and cannot be generalized to different scenarios. Moreover, these methods require costly hardware and under-consider road conditions. In this study, the ego lane, which is the lane a car is currently traveling on, is detected. This study proposes an adaptive hybrid lane detection method that adopts the advantages of traditional vision-based and machine-learning-based approaches. The proposed method involves a set of preprocessing methods for obtaining the candidate lane borders from an image in any degraded state. Subsequently, numerical features about the boundaries of the candidate lanes are extracted and used by a model of the k-nearest neighbor algorithm and the Gaussian process for final lane discovery. A set of experiments were conducted using the KITTI dataset to evaluate the performance. The results show that the proposed method overcomes various challenges. It is relatively simple and fast; it requires low-cost devices and processes and can be generalized without major modifications.

Background: Arbuscular mycorrhiza (AM) refers to a symbiotic association between plant roots and fungi that enhances the uptake of mineral nutrients from the soil and enables the plant to tolerate abiotic and biotic stresses. Although previously reported RNA-seq analyses have identified large numbers of AM-responsive genes in model plants, such as Solanum lycopersicum L., further studies are underway to comprehensively understand the complex interactions between plant roots and AM, especially in terms of the short- and long-term responses after inoculation. Results: Herein, we used RNA-seq technology to obtain the transcriptomes of tomato roots inoculated with the fungus Rhizophagus irregularis at 7 and 30 days post inoculation (dpi). Of the 1,019 differentially expressed genes (DEGs) in tomato roots, 635 genes showed differential expressions between mycorrhizal and non-mycorrhizal associations at the two time points. The number of upregulated DEGs far exceeded the number of downregulated ones at 7 dpi, and this difference decreased at 30 dpi. Several notable genes were particularly involved in the plant defense, plant growth and development, ion transport, and biological processes, namely, GABAT, AGP, POD, NQO1, MT4, MTA, and AROGP3. In addition, the Kyoto encyclopedia of genes and genomes pathway enrichment analysis revealed that some of the genes were involved in different pathways, including those of ascorbic acid (AFRR, GME1, and APX), metabolism (CYP, GAPC2, and CAM2), and sterols (CYC1 and HMGR), as well as genes related to cell division and cell cycle (CDKB2 and PCNA). Conclusion: These findings provide valuable new data on AM-responsive genes in tomato roots at both short- and long-term postinoculation stages, enabling the deciphering of biological interactions between tomato roots and symbiotic fungi. [ABSTRACT FROM AUTHOR]

Background: The “terrible triad injury of the elbow” is complex fracture dislocation injury comprising a notorious combination of elbow dislocation and fractures of the coronoid process and radial head. Objectives: The work aimed to demonstrate the results of radial head prosthetic replacement in management of fracture head of radius in terrible triad injury of the elbow in terms of clinical and radiological outcomes. Patients and methods: This is a retrospective study that includes 20 patients that fulfilled inclusion criteria, presented with terrible triad injury of the elbow to Qena University Hospital trauma unit in the period between July 2018 and August 2022, managed with prosthetic replacement of the radial head using non-modular metal spacer and reconstruction of elbow ligaments. Results: We found that most patients (18 patients, 90%) reported return to previous work and daily activity, at least14 patients (70%) reported good functional ROM in their last follow-up with mean MEPS and QuickDASH scores 76 and 37.09 points, respectively. On the other hand, there was a high rate of complications. Most significantly, two patients (10%) experienced residual valgus instability. Another two (10%) patients demonstrated heterotrophic calcification. Four (20%) patients suffered nerve injury. Conclusion: Current surgical protocols made it possible to achieve acceptable outcome and regain the joint function using economically affordable, cost-effective, non-modular prosthesis. However, there is still significant risk of long-term disability and high rate of complications.