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This review aims to present the unique considerations for manufacturing and the regulation of new vaccines in Muslim-populated countries such as Malaysia. Our specific objectives are to highlight vaccine production and the ingredients of concern, summarize the current mechanism for ruling and recommendations on new vaccines, outline the different steps in decision-making on incorporating a new vaccine into the National Immunization Program, describe its issues and challenges, and explore the commercial viability and challenges of producing local permissible (halal) vaccines. Through this review, we hope readers understand that alternatives are present to replace ingredients of concern in vaccines. Halal certification and introduction of a new vaccine into a program are strictly conducted and health-care providers must be prepared to educate the public on this. At the same time, it is hoped that the production of halal vaccine in Malaysia will promote self-reliance in Muslim-populated countries.

Purpose Sustainability within supply chains is a paramount international concern, particularly in light of the challenges they encounter globally, exemplified by the Russian-Ukrainian conflict and the preceding COVID-19 pandemic. Furthermore, the Climate Conference in Egypt in November 2022 demonstrates the prevailing global emphasis on sustainability, particularly in sustainable supply chains. Researchers have identified that supply chain technology will significantly contribute to achieving sustainability across its three dimensions: economic, environmental, and social, while noting a research gap in prior studies regarding the application of supply chain technology in business contexts. The purpose of the research is to explore the effects of digital transformation practices on sustainable supply chains through the mediation role of green innovation. The research aims to fill a theoretical gap in digital transformation research in sustainable supply chain tracks in Egypt, where it is under-researched.Design/methodology/approachThe present study follows the quantitative research methodology and uses the survey list for collecting primary data by conducting it on a sample of 266 managers of industrial exporting companies in Egypt. The research is exploratory research using regression modeling, which combines theory with data to test hypotheses and explain behavior.FindingsThe study findings indicate that digital transformation profoundly influences supply chain sustainability by enhancing operational efficiency, transparency, and resilience, while also promoting environmental and social accountability. Green innovation plays a pivotal role in enhancing sustainable supply chains by integrating eco-friendly practices, improving resilience, and fostering competitive advantages.Practical implicationsBy implementing sustainable supply chain practices, the findings of this study will help the industrial enterprises under examination keep up with contemporary advancements in digital transformation and manufacturing. This includes adopting green innovation methods and introducing innovative processes, services, and products. The aim is to guarantee the uninterrupted operation and long-term viability of supply chains for these industrial enterprises. Moreover, it aligns with Egypt's sustainable development strategies.Originality/valueThe research contributes by highlighting the critical role of information systems and digital transformation in advancing sustainable supply chain management. Received on: 26 Novamber 2024 Accepted on: 04 January 2025 Published on: 02 February 2025

Abstract Background Globally, breast cancer ranks among the most common malignancies and has a high mortality rate. Invasive breast carcinoma of no special type (IBC-NST) presents a heterogeneous group with variable prognosis. Identifying reliable biomarkers is crucial for improving treatment strategies and predicting outcomes. This study investigates the immunohistochemical expression of parathyroid hormone-related protein (PTHrP) and ezrin in IBC-NST and their correlation with clinicopathological features and overall survival. Methods This retrospective study analyzed 160 paraffin-embedded tissue samples, including 123 IBC-NST and 37 normal breast tissues, collected from patients treated at Menoufia University Hospital during the period from January 2018 to January 2022. Immunohistochemical staining for PTHrP and ezrin was performed, and expression levels were quantified using the H score. Results PTHrP expression was significantly higher in IBC-NST than in adjacent DCIS and normal tissues (p

Abstract Background Cardiac surgery is a major contributor to acute kidney injury (AKI); approximately 22% of patients who undergo cardiac surgery develop AKI, and among them, 2% will require renal replacement therapy (RRT). AKI is also associated with heightened risks of mortality and morbidity, longer intensive care stays, and increased treatment costs. Due to the challenges of treating AKI, prevention through the use of care bundles is suggested as an effective approach. This review aimed to assess the impact of care bundles on kidney outcomes, mortality, and hospital stay for cardiac patients in critical care. Methods PubMed, Scopus, Web of Science, and EMBASE were searched up to November 2024. Inclusion criteria were studies on individuals with cardiac diseases receiving critical care, that used AKI care bundle as the intervention, and reported outcomes related to AKI, mortality, and other kidney-related events. We used the Cochrane Collaboration’s risk of bias tool 2 and the Newcastle-Ottawa scale for quality assessment. Pooled odds ratios (ORs) or risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Results Seven studies on total 5045 subjects, including five observational and two randomized controlled trials (RCTs) were included. The implementation of care bundles significantly reduced the incidence of all-stage AKI (OR: 0.78; 95%CI: 0.61–0.99) and moderate-severe AKI (OR: 0.56; 95%CI: 0.43–0.72). Also, the implementation of care bundle increased the incidence of persistent renal dysfunction after 30 days by 2.39 times. However, there were no significant changes in RRT, major adverse kidney events, or mortality between the groups. The mean quality assessment score for observational studies was 7.2 out of ten, while there were noted concerns in the risk of bias assessment of the RCTs. Conclusions The application of care bundles in patients, including those undergoing cardiac surgeries as well as non-cardiac critical illness, appears to be effective in reducing AKI, particularly in moderate and severe stages. However, given the inclusion of non-cardiac patients in some studies, the observed effect may not be solely attributable to cardiac surgery cases. Future large-scale RCTs focusing specifically on cardiac surgery patients are recommended to clarify the impact of care bundles within this subgroup. Registration ID in PROSPERO CRD42024498972.

Background: Pediatric strabismus surgeries have frequently been linked to the occurrence of oculocardiac reflex (OCR). This study aimed to assess the efficacy and safety of peribulbar and sub-tenon blocks on the occurrence of OCR during pediatric strabismus surgeries. Materials and Methods: A randomized, double-blinded trial was conducted with 120 children (ASA I/II) scheduled for strabismus surgery. Patients were randomized into three groups: control (intravenous paracetamol 15 mg/kg), sub-tenon (0.08 mL/kg of 0.5% bupivacaine), and peribulbar (0.25 mL/kg of a 1:1 mixture of 0.5% bupivacaine and 2% lidocaine). The study assessed the incidence rate of OCR as well as the time of occurrence of OCR after induction, hemodynamic variables, postoperative pain and analgesic requirements, the incidence of postoperative vomiting (POV), complications resulting from the orbital regional anesthesia, and total intraoperative atropine requirements. Results: The OCR incidence did not differ significantly between groups. Twenty-three patients (57%) in the sub-tenon group, 14 patients (35%) in the peribulbar group, and 14 patients (35%) in the control group experienced OCR (P = 0.063 and 0.201). All OCR cases were treated with atropine. Pain scores at 4 h post-surgery were significantly higher in the sub-tenon and peribulbar groups compared to the control group (P = 0.001 and 0.041, respectively). The sub-tenon group had one case of POV, whereas the control group had five cases (P = 0.025). Conclusion: Both sub-tenon and peribulbar blocks effectively reduced POV and analgesic requirements in pediatric strabismus surgery, but did not prevent the occurrence of OCR.

Background/aim Epilepsy is a brain disorder affecting individuals of all ages. It is one of the most common neurological disorders, affecting about 50 million people globally. The study objective was to study the different genotypes of Apolipoprotein E (APOE) gene among adult idiopathic generalized epileptic patients and to assess their influence on cognitive functions of those patients. Patients and methods Forty adult patients with idiopathic generalized epilepsy (IGE) and 20 healthy controls were enrolled in this study from Kafrelsheikh Governorate, Egypt. Patients were recruited from the Neurology Department at Kafrelsheikh University Hospital. Neuropsychological evaluation was conducted to all participants. Genotyping of the APOE gene polymorphisms (rs429358 and rs7412) was then carried out using both restriction fragments length polymorphism and Sanger sequencing to evaluate the correlation between the genotype and cognitive functions of patients with IGE. Results Most of the patients and controls showed the wild type genotype ε3/ε3 of both polymorphisms of APOE gene; rs429358 and rs7412. Only six patients and one control had different genotypes other than the wild type. The study showed that a highly significant association (P

Background and objective: It is widely accepted that the value of treatments for incurable metastatic cancer depends on their ability to improve overall survival (OS), quality of life (QoL), or both. Progression-free survival (PFS) is frequently used as a primary endpoint because of challenges in accurately assessing OS and QoL. The perceived value of extending PFS when there is uncertainty regarding the benefit to OS/QoL may vary between clinicians and patients. The aim of our study was to measure patient and clinician perspectives on what defines a clinically meaningful PFS benefit. Methods: We conducted an observational study using a self-administered questionnaire. Participants included patients with advanced prostate cancer (PC) and medical oncology clinicians treating patients with PC. The questionnaire presented a hypothetical scenario of metastatic castrate-resistant PC (mCRPC). Participants were asked about their willingness to undergo or prescribe treatment offering PFS benefits despite uncertain OS outcomes. Participants specified the minimum extension of PFS (ePFSmin) beyond the estimated 18-mo duration outlined in the scenario while considering varying toxicity levels. Key findings and limitations: Between April and May 2024, 54 patient responses and 27 clinician responses were received. Some 50/54 patient participants (92.6%) and 22/27 clinician participants (81.5%) expressed willingness to accept a prospective treatment associated with longer PFS but uncertain OS benefit. For treatment with no or mild toxicity, the median ePFSmin for treatment acceptance was >12 mo for patient participants and 3–6 mo for clinician participants. For treatment with severe toxicity, 40.7% of patients and 51.9% of clinicians would not accept treatment; the ePFSmin for treatment acceptance was 3–6 mo for patient participants and >12 mo for clinician participants. Conclusions and clinical implications: Most patients and clinicians are open to mCRPC treatment with evidence of PFS benefits despite OS uncertainty. Patients needed longer PFS extension to justify treatment but were more accepting of side effects and placed greater importance on a prostate-specific antigen or radiological response than clinicians. The relationship between ePFSmin and treatment acceptance according to toxicity levels for patients was unclear, limited by the nature of the self-administered questionnaires. Patient summary: We surveyed patients and doctors about their views on an imaginary treatment for advanced prostate cancer that could delay disease progression but with no certainty about whether it would extend life expectancy. Both patients and doctors were open to this treatment, but patients expected a longer delay in disease progression than doctors before being willing to accept this imaginary treatment. Many patients and doctors would also not consider the treatment if it caused severe side effects.

Background: Type I diabetes mellitus (T1DM) is one of the most common chronic autoimmune diseases worldwide. miRNAs are a class of small non-coding RNA molecules that have been linked to immune system functions, β-cell metabolism, proliferation, and death, all of which contribute to pathogenesis of TIDM. Dysregulated miRNAs have been identified in Egyptian TIDM patients. Aim: Several miRNAs were profiled in Egyptian TIDM patients to determine whether they can be used as molecular biomarkers for T1DM. The relationship between the investigated miRNAs and pro-inflammatory cytokines (TNF-α and IL-6) has also been evaluated in the development of TIDM, in addition to the creation of a proposed model for TIDM prediction. Patients & methods: Case-control study included 177 Egyptian patients with confirmed type I diabetes mellitus and 177 healthy individuals. MiRNA-34 and miRNA-146 were detected in serum samples using real-time PCR, whereas TNF-α and IL-6 levels were assessed using ELIZA. Results: Patients with TIDM showed a significant decrease in the expression of miRNA-146, with a cut-off value ≤ 3.3, 48 % specificity, and 92.1 % sensitivity, whereas miRNA-34 had the highest sensitivity (95.5 %) and specificity (97.2 %) for differentiating diabetic patients from controls. Furthermore, other diagnostic proinflammatory markers showed lower sensitivity and specificity. Conclusion: Serum levels of miRNA-34a, miRNA-146, IL-6, and TNF-α provide new insights into T1DM pathogenesis and could be used for screening and diagnosis purposes. They can be also a potential therapeutic target, as well as allowing for more strategies to improve T1DM disease outcomes.

Abstract Background Cellulose is the major part of lignocellulosic biomass. It can be hydrolyzed into glucose units via specific enzymes called cellulases that have been applied in many commercial fields. There are several studies illustrate the influence of enzymes on apple juice clarification. However, to the best of our knowledge, the effect of microbial cellulase on volatile compounds of apple juice is not well known. The present study aimed to assess the effect of cellulase from a new bacterial isolate on the physicochemical properties of apple juice as well as volatile compounds. The hydrolysis of some polysaccharides (cellulose, hemicellulose, pectin) and polyphenols during apple juice production is necessary to reduce cloud sedimentation or color deterioration and increase the yield of juice. So, enzymes from new microbial isolates serve as processing aids to obtain clear juice with a high yield. Results Cellulase-producing bacterium was isolated, characterized and molecularly identified as Bacillus licheniformis strain-MA1 with an accession number of ON840115. Optimization of medium parameters was implemented using Plackett–Burman design (PBd) followed by Box-Behnken design (BBd) of response surface methodology (RSM). The PBd revealed the three most important (significant) variables including carboxymethyl cellulose (CMC), corn cob, and peptone that had positive impact on cellulase production. Additionally, using the agricultural residue (corn cob) by the bacterial strain as a carbon source helps in reducing the costs of enzyme production, recycling the by-products, and preserving the environment. The optimized medium using PBd and BBd enhanced cellulase production from B. licheniformis strain-MA1 by 6.8-fold. A remarkable increase was observed in juice yield in enzyme treated-juice sample (88.2 ± 0.15%) in comparison with control juice (75.4 ± 0.09%). The total phenolic contents in cloudy and clarified apple juices were 0.957 ± 0.09 and 0.412 ± 0.03 mg/mL, respectively. Also, DPPH and FRAP assays showed a remarkable increase in antioxidant activity (Low IC50) in the control sample compared to enzyme treatment. Twenty-seven volatile compounds were extracted using headspace solid-phase microextraction-gas and analysis was performed by GC–MS. The identified volatile constituents belonged to several chemical classes: 15 esters; 6 alcohols; 4 aldehydes and 2 acids. The predominant class in apple juice volatile fraction was esters with a sweet and fruity odor. Conclusion The crude cellulase obtained from the novel bacterial isolate B. licheniformis strain-MA1 was successfully applied as a clarifying agent in apple juice.

Abstract Introduction Death certification is a health indicator and a public health surveillance tool. High-quality death certificate ensures reliability of mortality statistics used to direct the arranging of health-related programs and leading assessments of research and proper healthcare outcomes. The World Health Organization (WHO) puts Egypt in the group of ‘low quality’ death registration data. The aim of this study was to evaluate the impact of composite training and audit intervention on accurate completion of death notification forms (DNFs) in Assiut University Children Hospital (AUCH) that has an average monthly mortality of 120 children’s deaths. Methods A Quasi-experimental study design was conducted among residents of AUCH. The intervention consisted of 1- Preparing training material with basic information on how to report causes of death according to WHO criteria and case scenarios extracted from the medical records of children who died at AUCH, 2- One hundred residents of the AUCH were trained in one day workshops in 4 groups, with a pre-post knowledge assessment questionnaire. 3- A weekly audit of a sample of 10–15 DNFs was done for six months with reporting of findings to quality assurance director of the hospital. Results Eighty- nine physicians completed the pre-post knowledge assessment with significant increase in knowledge score after the intervention (15.7 ± 3.2 vs. 11.9 ± 2.8). There was a significant decrease in the errors of reporting on the DNFs. The main improvement was in decrease from 90 to 18% in reporting the mechanism of death, and significant decline in writing cause of death in Arabic language only. Conclusion Accurate reporting of the medical cause of death can be achieved by educational intervention targeting physicians with institutionalizing of audit system for continuous quality improvement.

Abstract Background In Yemen, effective early detection and a comprehensive grasp of breast cancer symptoms and risk factors are vital in preventing its potentially deadly spread. However, challenges arise in combating breast cancer in Yemen due to the lack of patient registries, national strategies, and structured cancer treatment plans. Objective This research sought to evaluate the awareness levels of breast cancer and the perceived obstacles to breast cancer screening among adult Yemeni women. Methods A community-based cross-sectional questionnaire study was conducted from September 2023 to January 2024 from two teaching and largest hospitals in the capital municipality, Sana’a, Yemen, where 533 women (≥ 18 years old) were conveniently selected in this study. Data were analyzed using SPSS software (version 23).. The Chi-square test was used to test associations. The factors associated with breast cancer awareness and barriers to breast cancer screening were analyzed separately, using multivariable logistic regression. Results The study revealed that 88.6% of women were familiar with breast cancer, and 61.9% being knowledgeable about screening methods such as clinical breast examination (CBE) or mammography. The primary hindrance to screening (84.1%, n = 53) was the absence of symptoms or pain. The second most common reason for not undergoing screening was a lack of understanding about breast cancer and its treatment (61.9%, n = 39). Conclusion To enhance breast cancer screening rates among Yemeni women consistently, targeted educational programs emphasizing the benefits of early detection and dispelling misconceptions and barriers related to the disease are essential.

Abstract Genetic generalized epilepsy (GGE) including childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy (JME), and GGE with tonic–clonic seizures (TCS) (GGE-TCS), is genetically influenced with a two- to four- fold increased risk in the first-degree relatives of patients. Since large families with GGE are very rare, international studies have focused on sporadic GGE patients using whole exome sequencing, suggesting that GGE are highly genetically heterogeneous and rather involve rare or ultra-rare variants. Moreover, a polygenic mode of inheritance is suspected in most cases. We performed SNP microarrays and whole exome sequencing in 20 families from Sudan, focusing on those with at least four affected members. Standard genetic filters and Endeavour algorithm for functional prioritization of genes selected likely susceptibility variants in FAT1, DCHS1 or ASTN2 genes. FAT1 and DCHS1 are adhesion transmembrane proteins interacting during brain development, while ASTN2 is involved in dendrite development. Our approach on familial forms of GGE is complementary to large-scale collaborative consortia studies of sporadic cases. Our study reinforces the hypothesis that GGE is genetically heterogeneous, even in a relatively limited geographic area, and mainly oligogenic, as supported by the low familial penetrance of GGE and by the Bayesian algorithm that we developed in a large pedigree with JME. Since populations with founder effect and endogamy are appropriate to study autosomal recessive pathologies, they would be also adapted to decipher genetic components of complex diseases, using the reported bayesian model. Graphical Abstract

Abstract The resilient modulus (MR) of different pavement materials is one of the most important input parameters for the mechanistic-empirical pavement design approach. The dynamic triaxial test is the most often used method for evaluating the MR, although it is expensive, time-consuming, and requires specialized lab facilities. The purpose of this study is to establish a new model based on Long Short-Term Memory (LSTM) networks for predicting the MR of stabilized base materials with various additives during wet-dry cycles (WDC). A laboratory dataset of 704 records has been used using input parameters, including WDC, ratio of calcium oxide to silica, alumina, and ferric oxide compound, Maximum dry density to the optimal moisture content ratio (DMR), deviator stress (σ d ), and confining stress (σ 3). The results demonstrate that the LSTM technique is very accurate, with coefficients of determination of 0.995 and 0.980 for the training and testing datasets, respectively. The LSTM model outperforms other developed models, such as support vector regression and least squares approaches, in the literature. A sensitivity analysis study has determined that the DMR parameter is the most significant factor, while the σ d parameter is the least significant factor in predicting the MR of the stabilized base material under WDC. Furthermore, the SHapley Additive exPlanations approach is employed to elucidate the optimal model and examine the impact of its features on the final result.

Abstract The current work looks at the inhibitory effects of a diolefinic dye, namely 1,4-bis((E)-2-(3-methyl-2,3-dihydrobenzo[d]thiazol-2-yl) vinyl) benzene iodide salt, in relation to CS corrosion mitigation in hydrochloric acid (HCl) environment. This study uses a variety of experimental methodologies, including weight loss (WL) analysis, electrochemical tests, and theoretical considerations. The synergistic effect of diolefinic dye and AgNPs on the corrosion inhibition of CS in 1 M HCl was investigated. The inhibition efficiency (IE) displays a notable enhancement as the concentration of the dye is elevated and as the temperature raises the IE increases. The diolefinic dye exhibited % IE of 83% even at low concentration (1 × 10–4 M) whereas 90% in the presence of (2.26 × 10–10) AgNPs. Tafel graphs demonstrate that the dye follows a mixed type inhibitor. The adsorption of the dye on CS surface follows Langmuir model. Moreover, the influence of temperature and the activation parameters disclose that diolefinic dye is chemisorbed on the CS surface. The synergistic coefficient of the diolefinic dye and AgNPs under various concentration conditions was greater than unity. The surface morphology of CS sheets was confirmed by scanning electron microscopy (SEM) and energy dispersive X-ray analysis (EDX). Density Functional Theory (DFT) calculations provide theoretical support for the inhibitory effects of the examined dye. Notably, there is a high agreement between the findings of practical studies and theoretical expectations.

Abstract A novel composite material, magnetic chitosan-clay/benzoin/Fe3O4 (CS-CY/Benz/Fe3O4), was synthesized for effectively removing thionine dye (TH) from water solutions. The structural integrity and suitability of CS- CY/Benz/Fe3O4 composite for adsorption purposes were validated through extensive characterization techniques including BET, XRD, FTIR, and SEM. The adsorption efficiency was optimized through a Box–Behnken design (BBD) employing response surface methodology (RSM), focusing on variables such as adsorbent dose (A: 0.02–0.08 g), solution pH (B: 4–10), temperature (C: 30–60 °C), and time (D: 5–30 min). Experimental results revealed a maximum TH removal of 99% with significant interactions between temperature (C) and time (D) (p-value = 0.0001). The optimal conditions for TH removal were determined as pH ~ 5.91, adsorbent dosage of 0.08 g, temperature of 54.34 °C, and time of 29.7 min. The investigation of kinetics revealed that the adsorption process conformed to a pseudo-second-order (PSO) model, while the equilibrium data were effectively described by the Freundlich isotherm model. At a temperature of 333.15 K and a TH concentration of 350 mg/L, the adsorption capacity was determined to be 660.86 mg/g. The mechanism of adsorption encompassed various interactions such as electrostatic attractions, n–π interactions, hydrogen bonding, and Yoshida H-bonding. Particularly, the CS-CY/Benz/Fe3O4 composite demonstrated strong magnetic responsiveness, enabling straightforward separation from water using an external magnetic field after adsorption. Particularly, the CS-CY/Benz/Fe3O4 composite demonstrated strong magnetic responsiveness, enabling straightforward separation from water using an external magnetic field after adsorption. This research contributes important findings to the advancement of magnetic chitosan-based composites for efficient removal of TH dye pollutants from water environments.

Abstract Background Enhancing the prognosis and treatment outcomes of oral cancer relies heavily on its early detection. This study aims to establish a connection between serum and salivary dipeptidyl peptidase-4 (DPP-4) levels and oral squamous cell carcinoma (OSCC), comparing them with oral potentially malignant lesions (OPMLs) and control subjects and validating salivary DPP-4 as a diagnostic marker for the early detection of oral cancer. Methodology Forty-five systemically healthy individuals were categorized into three groups: Group I consisted of 15 patients diagnosed with OSCC, Group II comprised 15 patients with OPMLs (including leukoplakia and oral lichen planus), and Group III included 15 participants without any oral mucosal lesions. Serum and whole unstimulated salivary samples were collected from all participants to assess DPP-4 levels using an enzyme-linked immunosorbent assay (ELISA) kit. Receiver operating characteristic (ROC) analysis was conducted to determine the area under the curve (AUC), sensitivity, specificity, and diagnostic accuracy of DPP-4. Results Both serum and salivary DPP-4 levels were highest in the healthy group, followed by OPMLs, and lowest in the OSCC group, with statistically significant differences observed. ROC analysis demonstrated excellent diagnostic accuracy of salivary DPP-4 in distinguishing OSCC from healthy individuals, OPMLs from healthy individuals, and OSCC from OPMLs, with accuracies of 100%, 100%, and 96.67%, respectively. Salivary DPP-4 levels also exhibited a statistically significant correlation with OSCC grades. Conclusions DPP-4 appears to play a protective, anti-oncogenic role in maintaining oral tissue health. The remarkable diagnostic accuracy of both serum and salivary DPP-4 in discriminating between OSCC, OPMLs, and healthy controls suggests its potential utility as a well-established marker for early oral cancer diagnosis. Salivary DPP-4, being non-invasive, could serve as a convenient chair-side diagnostic tool for the early detection of OSCC. Clinical trial registration The study was retrospectively registered on clinicaltrial.gov with NCT06087042, date of registration (first posted date): 17/10/2023

Abstract Background Disorders affecting the temporomandibular joint (TMJ), related structures, and the masticatory muscles are called temporomandibular disorders (TMD). The two most typical symptoms are mouth opening restriction and pain. Costen noted the connection between TMD and tinnitus in 1934. These conditions are brought about by the shared structures that connect the TMJ and the auditory apparatus (bones and muscles) through a shared innervation source and specific ligaments. Wright addresses Costen ideas, which suggest that otological symptoms of TMD could be caused by auriculotemporal nerve damage, Eustachian tube restriction, or other factors causing an incorrect intratympanic pressure adjustment. Methods Cross-sectional observation was regulated at Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University. The following are the inclusion criteria: patients with a TMD diagnosis and those older than 16 years old. The following conditions are excluded: neurological or oncological disorders, ear infection, and a history of face trauma. Results The total number was 196 patients, 63.8% females and 36.2% males. A total of 76.5% had bilateral joint pain, and 21.9% had unilateral joint pain. While 70.4% had bilateral muscle pain, 18.9% had unilateral muscle pain. A total of 91.8% had mild tinnitus, while 8.2% had moderate tinnitus. Conclusion In this study, 8.2% of patients complaining of tinnitus had severe tinnitus, while 91.8% had mild tinnitus.

Abstract Staphylococcus aureus produces a plethora of virulence factors to invade and establish infections in the host system, and biofilms are more resistant to antibiotics than planktonic cells. In this study, we aimed to investigate the anti-virulence and anti-biofilm potentials of zinc sulfate against S. aureus isolates. The synergistic effect of zinc sulfate in combination with antibiotics on S. aureus was characterized using the checkerboard method. The influence of zinc sulfate on biofilm formation and virulence factors production by S. aureus was experimentally assessed. RT-qPCR was used to investigate the effect of zinc sulfate on the expression of biofilm-related genes. Zinc sulfate exhibited good antibacterial activity against S. aureus with a MIC of 128 µg/ml against all tested isolates. Also, the findings indicate a synergistic effect of a combination of zinc sulfate and antibiotics against the tested isolates. Zinc sulfate at 256 µg/ml concentration inhibited biofilm formation for all isolates. The expression of biofilm-related genes was significantly repressed in zinc sulfate-treated bacteria compared to untreated cells. Zinc sulfate could inhibit the hemolytic ability of S. aureus. Moreover, zinc sulfate-treated bacteria exhibited a significant decrease in coagulase and catalase activity relative to control untreated S. aureus. Our results support that zinc sulfate is a potential antimicrobial and anti-virulence agent against S. aureus infections.