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Central diabetes insipidus (DI) is an uncommon condition caused by reduced or lack of vasopressin secretion from the posterior pituitary gland, typically caused by gland destruction. Several other causes for central DI have also been proposed. Here we present a case of transient central DI after discontinuation of vasopressin used for septic shock without evidence of overt pituitary damage in a cystic fibrosis patient. The serum sodium concentration peaked at 137 mmol/L in the setting of polyuria within 3 days of vasopressin discontinuation without other identified alternative etiologies. Sodium levels and urine output trended down dramatically with desmopressin administration.

Ahmed El-Massry, Khalid Rashid ,†Seham Saad, Ihab Osman Department of Ophthalmology, Alexandria Faculty of Medicine, Alexandria, Egypt†Professor Khalid Rashid passed away on January 9, 2021.Correspondence: Ahmed El-MassryDepartment of Ophthalmology, Alexandria Faculty of Medicine, Champollion Street, El-Khartoum Square, El Azareeta Medical Campus, Alexandria, 21131, EgyptTel +20 122 215 2435Email ahmad.elmassry@gmail.comPurpose: To assess the results of simultaneously performed femtosecond laser–assisted Keraring intrastromal corneal ring–segment insertion and corneal collagen cross-linking for the treatment of keratoconus.Patients and Methods: In this retrospective, noncomparative, interventional study, 30 eyes of 24 progressive-keratoconus patients of both sexes aged 18– 36 years old with poor best-corrected visual acuity (BCVA) and intolerance to contact lenses were included. All patients had been subjected to complete preoperative and postoperative ophthalmological examinations — unaided VA, BCVA, refraction, Pentacam, and contrast sensitivity examinations at 3-month, 6-month, and 1-year follow-ups.Results: Mean unaided VA had changed significantly from 0.649± 0.239 logMAR preoperatively to 0.514± 0.222 (P=0.014), 0.419± 0.162 (P< 0.001), and 0.379± 0.142 (P< 0.001) logMAR at the three follow-up visits, respectively. Mean BCVA had changed significantly from 0.326± 0.144 logMAR preoperatively to 0.231± 0.140 (P=0.006) at 1-year follow-up. Mean spherical equivalent refraction had decreased significantly at 6-month (P=0.0298) and 1-year follow-up (P=0.0081). Mean steep keratometry (K2) had also significantly reduced from 51.89± 3.81 D to 49.87± 4.57 D (P=0.034) at 6 months and 49.40± 4.39 D (P=0.011) at 1 year. Mean refractive and keratometric astigmatism had significantly decreased at all follow-up visits.Conclusion: At 1-year follow-up, keraring intrastromal corneal ring–segment insertion assisted by femtosecond laser performed simultaneously with corneal collagen cross-linking resulted in an improvement in visual, refractive, and topographic outcomes, which may suggest it is an effective treatment of keratoconus.Keywords: keratoconus, corneal collagen cross-linking, Pentacam, ICRS

Background Chest radiographs can identify important abnormalities in patients undergoing diagnostic evaluation for cardiovascular diseases. Cardiomegaly often reflects cardiac chamber dilation, or cardiac muscle hypertrophy, or both conditions. The clinical implications of cardiomegaly depend on the underlying clinical disorder. Does cardiomegaly have any clinical, laboratory, echocardiographic, and right heart catheterization associations in patients undergoing evaluation for pulmonary hypertension? Methods Patients referred to a pulmonary vascular disease clinic for possible pulmonary hypertension underwent a comprehensive evaluation that included right heart catheterization. These patients also had chest radiographs, laboratory studies, and echocardiograms. The patients were divided into two groups based on the presence or absence of cardiomegaly. Results This study included 102 patients (63.7% female) with a mean age of 62.3 ± 15.0 years. Patients with cardiomegaly (n = 64) had elevated BNP, BUN, and creatinine levels. They had elevated right atrial pressures, right ventricular pressures, and pulmonary artery pressures and reduced cardiac indices and reduced mixed venous oxygen saturations. There were no differences in echocardiographic parameters between the two groups. Conclusions This study demonstrates that the presence of cardiomegaly on chest radiographs has important clinical implications, including increased BNP levels and increased right heart pressures, in patients undergoing evaluation for pulmonary hypertension. Consequently, the presence of cardiomegaly supports the need for additional evaluation, including right heart catheterization, and provides useful information for primary care physicians and specialists.

Introduction: This study aimed to discover and document the potential of visual and ocular sequelae of computer vision syndrome (CVS) among medical students. Methods: This cross-sectional case-control study was conducted on medical students (n=4030) of five universities in Egypt. All students completed a specially designed and validated CVS questionnaire survey (CVS-F3). Students with ≥5 CVS symptoms constituted a risk group (n=352), while students with 1-4 CVS symptoms constituted a low-symptoms group (n=3067). Students from the control and risk groups were examined using objective methods, such as visual acuity, subjective refraction, dry eye disease tests, and anterior segment and fundus examinations. Students who complained of visual blur underwent multifocal electroretinography mfERG examinations (mfERG group). Results: The CVS-F3 indicated that 84.8% of students had complaints that might be related to CVS, however, our ophthalmic examination group revealed only a 56% CVS prevalence rate. The most common single screen type used by 70.4% of students was the smartphone, and the most common complaint was headache (50.2%). Multivariate logistic regression analysis revealed that CVS was significantly associated with increased screen-hours, including >2 screen-hours daily (odds ratio [OR], 2.48; P2 screen-hours at night (OR, 1.79; P=0.003), and ≥3 screen-years (OR, 1.69; P=0.006). In the mfERG group, 37% demonstrated reduced amplitudes of mfERG rings and quadrants, indicating reduced foveal responses. Conclusion: CVS-questionnaires overestimate the true CVS prevalence and sequelae, which could be accurately detected by objective ophthalmic examination. Smartphones primarily caused CVS among students, with CVS severity increasing in correlation with shorter eye-to-screen distance and frequent use. Contact lens wearing doubled the risk of CVS development and augmented its severity. CVS might affect macular integrity with screen-induced foveal dysfunction. Clinical Trials Registration: PACTR201811618954630.

Geranylgeraniol (GGOH) is found in edible oils such as olive, linseed, and sunflower oils, which have favorable metabolic effects. However, it is unknown whether these physiological benefits are mediated through the gut microbiome. Thus, the purpose of this study was to test the hypothesis that GGOH supplementation would improve glucose homeostasis and benefit the bone microstructure in obese mice through suppression of inflammation and modification of gut microbiota composition. Thirty-six male C57BL/6J mice were divided into 3 groups: a low-fat diet, a high-fat diet (HFD), and an HFD supplemented with 800 mg GGOH/kg diet (GG) for 14 weeks. Glucose and insulin tolerance tests were measured at baseline and end of study. The concentrations of adipokine cytokines (resistin, leptin, monocyte chemoattractant protein-1, interleukin-6) were measured via ELISA. Bone microarchitecture and quality were measured by micro-CT. Microbiome analysis was performed using 16S rRNA amplicon sequencing on cecal content. Relative to the HFD group, the GG group: (1) improved glucose tolerance and insulin sensitivity; (2) reduced production of pro-inflammatory adipokines, (3) increased serum procollagen I intact N-terminal propeptide (bone formation marker) concentrations, while decreasing serum collagen type 1 cross-linked C-telopeptide (bone resorption marker) levels, and (4) increased stiffness at both femur and LV-4 and cortical thickness at femoral midshaft. Compared to the HFD group, the GG group had an increased abundance of Butyricicoccus pullicaecorum and decreased Dorea longicatena in the cecal microbiome. Collectively, GGOH improves glucose homeostasis and bone microstructure in obese mice, probably via suppression of pro-inflammation and modification of microbiome composition.

Zinc phosphide toxicity is a rare entity that presents most frequently among farmers in developing countries who use it as a rodenticide. The phosphine gas released after the ingestion inhibits cytochrome c oxidase, disrupting the mitochondrial physiology and oxidative phosphorylation and causing myocardial stunning. Here we present a case of a 20-year-old man who attempted suicide with zinc phosphide toxicity. Initially, he was hemodynamically stable with a normal ejection fraction; however, in a few hours, he deteriorated quickly and became hemodynamically unstable, with rapid deterioration of his ejection fraction to 20%. He was started on norepinephrine and then dobutamine; however, he had cardiac arrest from refractory cardiogenic shock despite resuscitative measures.

PURPOSE: To evaluate an automated method for detecting the cone shape characteristics and to assess the cornea specialists' subjective variability of these measures using different maps. METHODS: Topographic images of the anterior and posterior surface of each eye were presented to 12 clinicians in two different types of map: tangential curvature and relative elevation to the best-fit sphere. They were asked to mark the cone center and its boundaries in the two maps without knowing that they belonged to the same patient. The results between the maps were compared to assess the subjective variability dependent on the map type and the automated method was compared against both estimations to assess its accuracy. RESULTS: Considering the results of anterior and posterior surfaces, there was low agreement between the cone center estimations using different types of maps for 10 of the 12 cases ( P < .05), whereas the comparison between the automated method and the two map estimations did not show differences in 11 of the 12 cases ( P > .05). There was high variability, up to 55%, among clinicians' estimations of the cone area. The results of the automated method were within the range of the expert's estimations. CONCLUSIONS: An objective, mathematically derived method of determining morphological dimensions of the cone was consistent with clinicians' evaluations. Although there was high variability among the experts' subjective estimates, which were highly influenced by the type of map, the objective method provided a reliable evaluation of the keratoconus shape independent of maps or color scale. [ J Refract Surg . 2021;37(6):414–421.]

Echocardiograms provide important information for the evaluation and management of patients with pulmonary hypertension. Right ventricular free wall strain measurements provide additional information about the longitudinal contractile function of the right ventricle. Clinical information, including echocardiographic measurements and right heart hemodynamic parameters, on patients undergoing right heart catheterization for evaluation of possible pulmonary hypertension was collected retrospectively. This study included 60 patients (35 women) with a mean age of 62.6 ± 14.8 years. For World Health Organization categories, 32 patients were in Group 1, 12 in Group 2, 4 in Group 3, 3 in Group 4, and 7 had mixed clinical features of both Group 2 and Group 3. The mean pulmonary artery pressure was 40.6 ± 13.2 mm Hg. The right atrial volume index had significant positive correlations with the brain natriuretic peptide level, right ventricular volume index, left atrial volume index, and right atrial pressure and negative correlations with the cardiac index and mixed venous oxygen saturation. The mean right ventricular free wall strain was −17.85 ± 5.56%; it did not have significant correlations with right heart hemodynamic parameters. Therefore, the right atrial volume index but not the right ventricular strain index provides important objective information for the evaluation of patients with possible pulmonary hypertension.

Purpose To assess the corneal endothelial cells morphology and count in keratoconus patients and their correlation with different stages of keratoconus. Methods Prospective non randomized multi-centric clinical study included 150 eyes of 150 keratoconus patients. Four centers in Egypt participated in this study included: Departments of Ophthalmology in Alexandria University, Tanta University and Port Said University and Alex I-Care hospital. Pentacam (Wavelight Oculyzer II) and specular microscopy (Tomey EM-3000) were done to all eyes. Keratoconic eyes were classified according to Amsler classification into stage 1, 2 and 3. Stage 1 included 99 eyes, stage 2 included 32 eyes & stage 3 included 19 eyes. Results The mean age of keratoconus patients was 24.07 ± 6.154 years. Forty five cases were males (30%) and 105 cases were females (70%). There was statistically significant difference in endothelial cell density (p p = 0.012) between different stages of keratoconus eyes. Regarding cell surface area, there was statistically significant difference in cell surface area between different stages of keratoconus eyes (p p Conclusions Qualitative and quantitative structural changes were seen in endothelial cells of keratoconus eyes by using specular microscopy. For stages 1 and 2, keratoconus may not affect the corneal endothelim significantly. The endothelium in stage 3 shows significant changes regarding polymegathism and pleomorphism.

Yogurt is considered a nutritional, healthy dairy product that is highly consumed worldwide produced via milk fermentation. The production process involves a standard starter culture of lactic acid...

Background The corneal cross-linking procedure has been proven to be an effective method to treat and stabilize keratoconus progression, but early vision rehabilitation is still needed in patients. Aim The aim was to compare the results of the combined CXL and intrastromal corneal ring segment implantation procedure to that of the cross-linking-alone procedure in terms of visual acuity, refraction, and some corneal topographic parameters in keratoconic patients. Design This was a prospective, comparative, and interventional study. Patients and methods This study was carried out on 44 keratoconic patients (60 eyes) of both sexes who ranged from 18 to 36 years. Thirty eyes were subjected to the CXL-alone procedure and 30 eyes were subjected to the combined procedure. Measurements were performed in all patients preoperatively and at 3, 6 months, and 1 year postoperatively including unaided visual acuity, best-corrected visual acuity, refractive, and topographic outcomes. Results Through the entire study period, both procedures were safe and effective in treating and stabilizing keratoconus progression. Furthermore, the combined group showed additional improvements over the CXL group for the following: UDVA at 3 months (P=0.0028), best-corrected visual acuity at 1 year (P=0.011), refractive and keratometric astigmatism at all follow-up visits and corneal asphericity at 3 months (P=0.013) and 6 months (P=0.0221) of follow-up. No severe intraoperative or postoperative complications were observed during the entire study period in either group. Conclusions The combined procedure is safe and effective for earlier improvement of visual and refractive outcomes in addition to the corneal stabilizing effect.

Eight F2 populations of crosses carried out between the resistant cultivar Amigo and 8 susceptible bread wheat cultivars were evaluated to study the inheritance of resistance to powdery mildew (Pm) caused byBlumeria. graminis f.sp . tritici and also to estimate the number and action of genes related to adult plant resistance. The response to powdery mildew disease was studied in a conditioned glasshouse and natural infection in the open field. Individual plants were scored and classified as resistant or susceptible according to a specific scale. The tested local wheat cultivars showed susceptible responses at both seedling and adult stages, while the Amigo cultivar was susceptible at seedling stage and resistant at adult stage. The F2 plants of all tested crosses were susceptible at seedling stage and resistant at the adult stage. Obtained results revealed that the inheritance of resistance is ruled by a single gene in the crosses Amigo/Sids12 and Amigo/Misr2; and by two recessive genes in Amigo/Gemmeiza11 cross. The inheritance of resistance in F2 populations of Amigo/Sakha95, and Amigo/Giza171 crosses is controlled by two dominant genes, while in Amigo/Gemmeiza12, Amigo/Sakha94 and Amigo/Misr1 crosses is conditioned by two incompatible dominant genes. Sakha 95 and Giza171 wheat cultivars were the best and suitable for transferring the adult plant resistance gene Pm17.

The experimental field work was conducted at Gemmeiza and Sakha Agricultural Research Stations, (ARC), Egypt, in 2017/18, 2018/19 and 2019/20 seasons to study the genetic behavior of grain yield and yellow rust resistance in three bread wheat crosses. The Genetic materials included (P1, P2, F1, F2, BC1 and BC2) of Gemmeiza 11× Giza168 (cross 1), Sids12 × Shandaweel1 (cross 2) and Gemmeiza 12 × Shandaweel 1 (cross 3). Significant differences were observed among most genotypes for measured traits. Additive gene effects were negative and highly significant in the first and the third crosses for No. days to maturity and grain yield plant-1 and in the second cross for No. spikes plant-1. However, it was positive and highly significant in the second cross for 100-kernel weight, yellow rust resistance and grain yield plant-1. Narrow sense heritability was ranged from moderate to high values for plant height, yellow rust resistance and No. kernels spike-1 in all studied crosses. These results could be employed to improve both yield and rust resistance in Egyptian wheat breeding program.

A diallel cross set was carried out at the Experimental Farm of Gemmeiza Agriculture Research Station, Agriculture Research Center, (ARC), Egypt, during the two winter seasons of 2017/2018 and 2018/2019 to assess the variations among six wheat genotypes and their new combinations to estimate heterosis, general and specific combining abilities to determine suitable measurements for drought tolerance in wheat genotypes. Genotypes and the resulted crosses mean squares were found to be either significant or highly significant for all the studied traits under normal and stress environments as well as the combined analysis, except for chlorophyll-a under drought. General combining ability and specific combining ability were found to be significant for all the studied characters under both conditions, except plant height for (SCA) under normal condition, chlorophyll-a for GCA under normal and drought as well as combined analysis and SCA under water-stress condition. The GCA/SCA ratios were found to be greater than unity, suggesting that, additive was much larger and more important than non-additive gene effects in the inheritance of these traits. The two parents Line 1 and Line 3 could be considered as excellent parents in breeding programs aimed to release drought tolerance cultivars. P1, P3, P4, P5 and P6 had the lowest drought susceptibility index value and F1 crosses P1xP2, P1xP3, P1xP4, P1xP5, P2xP6and P3xP5would be classified as drought tolerance due to the least reduction in yield under water stress compared to normal condition, such results might be useful for improving drought tolerance in wheat breeding program.

Introduction The aim of this study was to compare the efficacy of Photo-Activated Chromophore for Keratitis – Corneal Collagen Cross-linking (PACK-CXL) of three different total UVA fluence levels and topical voriconazole in treatment of fungal keratitis experimentally induced in rabbits. Methods This is an interventional experimental study including both eyes of 16 rabbits (32 eyes). Fungal keratitis was induced by intrastromal injection of Fusarium Solani into the cornea. The rabbits were then divided into four groups (8 eyes for each) from which group A received Voriconazole eye drops and considered as control group. Group B, C, D received single PACK-CXL session with total fluence levels of 7.2, 10.0 and 15.0 J/cm2 for each respectively. Daily clinical examination was recorded and all corneas were removed for microbiology and histopathology on day ten. Results The mean clinical signs score eyes treated with high fluence PACK-CXL showed evident clinical improvement from fourth to tenth day of treatment. This improvement was equivalent to that of Voriconazole treatment. The results showed better improvement with increasing the UVA total fluence levels but this difference was not statistically significant (P < 0.05). Similarly, the median CFU/ml declined on increasing UVA fluence but with no statistically significant values. Histopathological examination revealed better improvement of inflammatory signs on higher fluence levels compared to lower ones. Conclusions High intensity PACK-CXL (30 mW/cm2) was as effective as Voriconazole in the treatment of fungal keratitis in rabbits. Increasing the fluence of UVA was associated with slightly better clinical outcomes with no added risks. More clinical studies are needed to confirm these results.

We report a case of a patient that was implanted with an intracapsular ring during phacoemulsification cataract surgery. Namely, we report on refraction, posterior capsule transparency and IOL ACD and document photographically the appearance of the posterior capsule. It is suggested that the presence of the intracapsular ring has inhibited epithelial cell migration and prevented the formation of posterior capsule opacification (PCO) in the postoperative interval of 7 months. A comparison with the fellow eye of the same patient is made.

Food contaminants represent food constituents that are accidentally introduced during food preparation cycle. In addition to their direct toxic effects on human health at different levels, they influence both gut microbiota composition and function. This often leads to metabolic disorders linked to many aspects of the human body. Foods are poisoned with physical, chemical, or biological factors either in agriculture or during processing steps. These include naturally occurring compounds such as mycotoxins, agricultural chemicals such as pesticides and antibiotics, persistent organic pollutants, thermal process contaminants (e.g., furans, aromatic compounds, and nitrosamines), or heavy metals. These xenobiotics cause a wide range of toxicities. They also disturb gut homeostasis by inducing intestinal damage and inflammation and gut microbiota dysbiosis. We present herein the first comprehensive review of how food contaminants can specifically influence gut microbiota and intestinal homeostasis, and likewise via gut microbiota-mediated contaminants metabolism. The first part summarizes the different classes of food contaminants and their impact on gut microbiota and its homeostasis, while, the second part discusses the promising role of the gut microbiota in the biodegradation of these xenobiotics and the possible unfortunate exaggerated toxicities in some cases. Finally, we summarize the novel strategies to minimize toxic effects of food contaminants and future directions needed to explore the interactions between food contaminants and the gut microbiota.

Acute decompensated heart failure (ADHF) is the leading cause of hospitalization in patients older than 65 years. It continues to increase in prevalence and is associated with significant mortality and morbidity including frequent hospitalizations. The American Heart Association is predicting that more than 8 million Americans will have heart failure by 2030 and that the total direct costs associated with the disease will rise from $21 billion in 2012 to $70 billion in 2030. The definition of ADHF has important limitations, and its management differs significantly from that of chronic heart failure. Although many large, randomized, controlled clinical trials have been conducted in patients with chronic heart failure, it was not until recently that more studies began to address the management of ADHF. The mainstay of ADHF management involves identification of precipitating factors, oxygen supplementation, sodium and fluid restriction, and diuresis. The phenomenon of diuretic resistance is a significant obstacle to relief of congestion and is a field of active investigation. Other important adjuncts to treatment include noninvasive ventilation, inotropes, vasopressors, nitrates, opiates, and vasopressin receptor antagonists. In this review, we will discuss the terminology and classification of ADHF, and review the multiple modalities and strategies available for the management of this disorder. Keywords: heart failure, medical management, complications, devices, palliative care

Acute decompensated heart failure is a clinical syndrome involving the congestion of vital organs, such as the kidneys, liver, and brain, leading to loss of autoregulation and multiorgan failure. The interaction between organ systems is bi-directional and complex; it cannot be explained by hypoperfusion alone. Despite the multiple signs and symptoms that arise with systemic congestion, there are limitations in the assessment of volume status based only on clinical evaluation. Invasive hemodynamic monitoring is an adjunctive diagnostic and prognostic tool in acute decompensated heart failure when standard therapy fails and/or leads to worsening renal function as well as for the evaluation of advanced therapy options. This review will discuss the use of temporary mechanical circulatory support devices in cardiogenic shock and the expected outcomes for advanced heart failure with the implementation of left ventricular assist devices and cardiac transplantation.