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Sulafah Abdelgalil Ali Ahmed,1,2 Mohammed Elmujtba Adam Essa,3,4 Amar F Ahmed,5 Elnour Mohammed Elagib,2,6 Noha Ibrahim Ahmed Eltahir,2,6 Huyam Awadallah,7 Abubakr Hassan,3 Amna Sirag Mohammed khair,8 Mustafa Abdalla bakhit Ebad4 1Department of Medicine, Faculty of Medicine, Ahfad University, Khartoum, Sudan; 2Department of Rheumatology, Omdurman Military Hospital, Khartoum, Sudan; 3Department of Clinical Medicine, Medical and Cancer Research Institute, Nyala, Sudan; 4Faculty of Medicine, Al Fashir University, Al Fashir, Sudan; 5Department of Internal Medicine, Wayne State University, Detroit, MI, USA; 6Department of Medicine, Faculty of Medicine, Karrary University, Khartoum, Sudan; 7Department of Internal Medicine, Detroit Medical Centre, Detroit, MI, USA; 8Department of Medicine, Sudan Medical Specialization Board, Khartoum, SudanCorrespondence: Mohammed Elmujtba Adam EssaDepartment of Clinical Medicine, Medical and Cancer Research Institute, Nyala, SudanTel +24990700938Email Awadali818@yahoo.comBackground: Mixed connective tissue disease (MCTD) is a rare autoimmune disease, characterized by the production of specific autoantibody anti-RNP, which presents with varied overlapping symptoms of different connective tissue disorders. The aim of this study is to identify the frequency and patterns of MCTD.Methods: This is a descriptive cross-sectional hospital-based study conducted at the rheumatology clinic at Omdurman Military Hospital between February 2019 and July 2019. The study included 30 patients and data were collected using a designated questionnaire.Results: The study showed that the majority of patients (96.7%) were females and only 3.3% was male. About 30% of the patients aged between 30 and 39 years were the most affected. As a first diagnosis, 10% of the patients had a MCTD fulfilling the Alarcon-Segovia criteria. The remaining 90% of the patients were diagnosed with other diseases before evolving into MCTD. The most common clinical presentation was arthralgia in 100% of the patients, 90% were symmetrically followed by myositis in 70% of the patients, arthritis in 63.3% of the patients, puffy fingers in 63.3% of the patients, and hand swelling in 60% as major musculoskeletal symptoms. Regarding the initial results in immunological profile, the most common positive autoantibodies among the patients were anti-RNP titer in 96.7% of the patients, ANA in 90%, anti-Sm in 50%, RF in 50%, anti-Ds DNA in 46.7%, and anti-Ro in 43.3%.Conclusion: This study showed that MCTD is more common in females, only 10% of patients presented with a fulfilling criteria of the disease at diagnosis, and the rest of the patients presented with other rheumatologic diseases before evolving into MCTD.Keywords: MCTD, females, arthralgia, anti-RNP titer

Abstract Background Hemodynamic monitoring is a cornerstone of critical care; in fact, the techniques available for this purpose are either unreliable or operator-dependent or intermittent (echocardiography) and invasive (thermodilution). Objectives: To evaluate the effectiveness of electrical cardiometry (EC) in assessing hemodynamics in pediatric postoperative cardiac intensive care unit (ICU) and the agreement between EC and trans-thoracic echocardiography (TTE) as bedside tools for hemodynamic monitoring and early diagnosis of cardiovascular compromise. We included 70 pediatric patients from the postoperative cardiac ICU. All participants underwent history-taking and clinical examination. emphasising vital signs, manifestations or signs of hemodynamic instability, calculation of RACH score and vasoactive inotropic score. EC was applied for all patients, and TTE. Results The study included 40 males and 30 females with a mean age of 2.6 ± 3.49 years, ranging between 2 weeks and 13 years, with a male to female ratio of 1.3:1. The median of EC parameters were comparable to TTE parameters stroke volume (SV) (9 vs. 8 p = 0.2), stroke index (SI) (23.5 vs. 22 p = 0.2), cardiac output (CO) (1.25 vs. 1.1 p = 0.3), and cardiac index (CI) (3.2 vs. 3.15 p = 0.2). Hemodynamic parameters correlated significantly between EC and echocardiography, with significantly observed agreement between them. Four equations were postulated successfully based on a linear regression model to predict echocardiographic hemodynamic parameters in comparable groups of children, i.e., SV, SI, CO, and CI. Conclusion EC is an excellent alternative to echocardiography in hemodynamic assessment of cardiac patients in the postoperative ICU.

Cancer diseases and microbial infections are the subject of several ongoing recent researches. In this paper, aqueous extract of red and yellow Astragalus sarcocolla gum was used as safe and green agent, for the synthesis of novel biologically active silver-nanoparticles. Six silver nanoparticles (AgNPs) with different characters were obtained using sarcocolla gum at (5, 10 and 20 mg/ml (w/v)) concentrations. All biosynthesized AgNPs were characterized using UV–visible spectroscopy, Transmission Electron Microscopy (TEM), and Dynamic light scattering (DLS). Cytotoxic effect of sarcocolla gum-AgNPs against five human cancer cells and one normal cells was determined using the MTT (3-(4, 5-dimethylthiazol-2-yl)-2, 5- diphenyltetrazolium bromide) assay. The semi rounded particles formed from 5mg/ml red gum (AgNPs-RG1) and having 9.23±3.66 nm size range were the most active and possessed high cytotoxic effect against, A549 lung, pc3 prostate, Mcf-7 breast and paca2 pancreatic cancers, with IC50 values (88.4,75.6, 72.2& 55.0 ug/ml, respectively), but showed low cytotoxic effect (20 % at 100ug/ml) against human normal cells (BJ-1). On the other hand, the spherical to cubic shaped nanoparticles obtained from 5mg/ml yellow gum (AgNPs-YG1) with 10.92 ± 5.48 nm size range, showed good cytotoxic effect against three cancer cells (PC3 prostate, MCF-7 breast and paca2 pancreatic) with IC50 values (75.0, 82.8 and 81,6ug/ml respectively), and normal cells(BJ-1) with IC50 value (81.8ug/ml). Antibacterial and antifungal activities of the synthesized red and yellow gum-mediated AgNPs with different sizes and shapes were also investigated. Particles biosynthesized from 5 and 10 mg/ml red gum (AgNPs-RG1, RG2) and 5mg/ml yellow gum (AgNPs-YG1) exhibited broad spectrum antimicrobial effects against all tested pathogenic gram-positive, gram-negative bacterial strains, unicellular yeast and filamentous fungi. Based on these results, it can be concluded that the synthesized silver nanoparticles from low concentrations of sarcocolla gum have significant biomedical applications. [ABSTRACT FROM AUTHOR]

Human motion detection technology holds significant potential in medicine, health care, and physical exercise. This study introduces a novel approach to human activity recognition (HAR) using convolutional neural networks (CNNs) designed for individual sensor types to enhance the accuracy and address the challenge of diverse data shapes from accelerometers, gyroscopes, and barometers. Specific CNN models are constructed for each sensor type, enabling them to capture the characteristics of their respective sensors. These adapted CNNs are designed to effectively process varying data shapes and sensor-specific characteristics to accurately classify a wide range of human activities. The late-fusion technique is employed to combine predictions from various models to obtain comprehensive estimates of human activity. The proposed CNN-based approach is compared to a standard support vector machine (SVM) classifier using the one-vs-rest methodology. The late-fusion CNN model showed significantly improved performance, with validation and final test accuracies of 99.35 and 94.83% compared to the conventional SVM classifier at 87.07 and 83.10%, respectively. These findings provide strong evidence that combining multiple sensors and a barometer and utilizing an additional filter algorithm greatly improves the accuracy of identifying different human movement patterns.

Abstract The aim of this research is to present correction factors for the punching shear formulas of ACI-318 and EC2 design codes to adopt the punching capacity of post tensioned ultra-high-performance concrete (PT-UHPC) flat slabs. To achieve that goal, the results of previously tested PT-UHPC flat slabs were used to validate the developed finite element method (FEM) model in terms of punching shear capacity. Then, a parametric study was conducted using the validated FEM to generate two databases, each database included concrete compressive strength, strands layout, shear reinforcement capacity and the aspect ratio of the column besides the correction factor (the ratio between the FEM punching capacity and the design code punching capacity). The first considered design code in the first database was ACI-318 and in the second database was EC2. Finally, there different “Machine Learning” (ML) techniques manly “Genetic programming” (GP), “Artificial Neural Network” (ANN) and “Evolutionary Polynomial Regression” (EPR) were applied on the two generated databases to predict the correction factors as functions of the considered parameters. The results of the study indicated that all the developed (ML) models showed almost the same level of accuracy in terms of the punching ultimate load (about 96%) and the ACI-318 correction factor depends mainly on the concrete compressive strength and aspect ratio of the column, while the EC2 correction factor depends mainly on the concrete compressive strength and the shear reinforcement capacity.

The Industrial Internet of Things (IIoT) promises automation, efficiency, and data-driven decision-making by real-time data collection and analysis. However, traditional IIoT architectures are cloud-centric and, therefore, struggle to handle large volumes of data, edge bandwidth constraints, and data confidentiality. Distributed edge-to-cloud computing emerges as a potential solution, also paving the ground for edge-to-cloud data analytics and distributed Artificial Intelligence (AI) to obtain insights for decision-making and predictive maintenance. Despite the potential, however, there is a lack of comprehensive studies identifying key requirements for distributed edge-to-cloud IIoT and analyzing to what extent emerging IoT platforms meet those requirements. The scope of this article is to survey existing literature to identify key requirements in IIoT from the perspective of distributed edge-to-cloud computing. We provide a comparative analysis of three prominent IoT platforms, namely ThingsBoard, Eclipse Ditto, and Microsoft Azure IoT, and assess how these platforms meet the key IIoT requirements. Finally, we identify open challenges and potential research opportunities based on the insights gained from the analysis of the three IoT platforms, thereby setting the stage for future work.

Background: Early-onset colorectal cancer (EO-CRC) incidence and prevalence trends in the rise in high income countries, such as the Gulf Cooperation Council (GCC) countries. The study aimed to offer an up-to-date assessment of the overall burden of CRC, and EO-CRC in GCC countries and project its incidence and mortality in 2030. Method: The prevalence, incidence, mortality, years of life lived with disability (YLDs), and disability-adjusted life years (DALYs) of CRC were obtained from the Global Burden of Disease (GBD) Study 2019. The incidence and mortality of CRC, and EO-CRC up to 2030 were predicted. Results: All GCC countries showed a higher annual average percentage changes (AAPC) AAPC incidence rate for EO-CRC compared to CRC. In Saudi Arabia the number of CRC cases has increased from 1990 1484.57; (95 % UI 1987.98,1083.86) 11.4-fold-increase to 16991.83; (95 % UI 21754.79,12892.12) in 2019. In 2030, the total incidence cases of CRC for the six Gulf countries are expected to reach 13,339 thousand, primarily driven by Saudi Arabia with 7,910.19 cases. In 2030, the CRC mortality rate is projected to be 7,647 cases, with nearly 57 % of CRC mortality cases anticipated in Saudi Arabia. Conclusion: This study sheds light on the alarming rise in CRC and EO-CRC across Gulf countries from 1990 to 2019, emphasizing Saudi Arabia's significant burden. It projects a concerning increase in CRC incidence and mortality by 2030, primarily in Saudi Arabia, and highlights the need for immediate public health interventions.

OBJECTIVES This study aimed to determine the future preferences of house officers when choosing a medical speciality. METHODOLOGY The cross-sectional study was conducted from January to June 2023 at three teaching hospitals in Abbottabad. 250 participants were selected as the study sample. The data was collected from house officers on a predesigned, self-structured written questionnaire. The data was analyzed using SPSS version 21. RESULTS Of 250 individuals, 224 met inclusive criteria; 65% (146) were male and 35% (78) were female. The mean age was 25 years ±1.01. The first preference of the house officer was medicine (44% (100), the second was surgery (31.5%) (70), and the third was obstetrics and gynaecology. Among medicine specialities, only 0.9% (02) opt endocrinology and gastroenterology, while among surgical specialities, 0.4% (01) opt urology and 0.9% (02) opt neurosurgery. 150 individuals (70%) planned residency in the future, among whom 47% (106) set a caveat for residency abroad. The most favourite place abroad was the UK, with 42% (45/106). 180 house officers (80%) are satisfied with their academic abilities. CONCLUSION The study revealed that house officers have no awareness of new specialities and are least interested in specialities like endocrinology, gastroenterology, neurosurgery, and urology. In contrast, no influence was noted toward specialities like haematology, public health and community medicine. Most students are satisfied with their medical education but plan to do their residency abroad.

The geographical nature of the Hashemite Kingdom of Jordan is distinguished by its environmental diversity and its climatic conditions, in addition to the richness and diversity of cultural legacies that appear clearly in the spaces interior design of the traditional Jordanian houses.This architectural heritage, is considered one of the most important elements in preserving the special characteristics of peoples and nations and the distinctive cultural differences. And with the growing interest in the environmental design elements, it was found that many of the old designs carry a lot of elements and treatments that exploited or employed the available environmental elements to provide the highest levels of comfort in houses design. This is because it works to enhance the internal environment by employing the available environmental elements to reduce and limit the negative impacts on the environment and construction, in addition to using the natural environment to enhance the internal environment, which works to provide the highest levels of comfort in designing, reducing energy consumption and preserving the environment.The study will examine the green design, the concept of green architecture, the features of green buildings and the foundations on which the green design is based, in order to identify the suitability of the interior design of these buildings with green architecture.The research depends on monitoring and analyzing the similarities and differences between the heritage houses in some areas of the Hashemite Kingdom of Jordan and its internal spaces, to reach the most important points that must be restored and preserved. thus, listing them and developing proposals for ways to restore and preserve them.

Abstract Coronavirus (COVID-19) was a pandemic disease that was affecting our medical and surgical daily practice badly. The surgical management of acute appendicitis was the gold standard, but new studies suggest the safety of antibiotic treatment alone. Non-operative treatment for simple acute appendicitis (NOTA) avoids surgery, the risks of general anesthesia, and long hospital stays. It also decreases the risk of exposure to coronavirus. We aimed to study the cost-effectiveness and outcome of NOTA during the COVID-19 pandemic and compared it to single-incision pediatric endo-surgery appendectomy (SIPESA). A prospective cohort study for NOTA of patients from 6 to 12 years old in the COVID-19 pandemic period from April 1st, 2020, to April 30th, 2021, patients were divided into two groups: Group S was managed by SIPESA, and Group N was managed by NOTA. Family education and assurance with detailed explanation were done for early detection of any complications, and we continue monitoring the patients until their complete recovery. Group S had 24 cases (40%), mean age 9.3 years. Group N had 36 cases (60%), mean age 9.1 years. Six cases (17%) in group N were converted to surgical management in the first 6 months of the study. The mean cost dropped from $2736/day to $400/day. The mean psychological stress for the children improved from 4.4 in April to 2 in September. The mean follow-up was 3.5 months. NOTA is a feasible, cost-effective approach, and we recommend it, as we have learned this lesson during the COVID-19 pandemic days.

The interior designer a lot of challenges is located in the design process to make interior design consistent with the environmental, cultural and religious conditions, and thanks to modern technology that led to the events of successive architectural transformations in response to the many in the communications and information technology developments.Within this large development in technology and communications, it appeared many new concepts in the field of interior design, which seeks to meet human needs and requirements of the future, aimed at these concepts in turn to take advantage of the technology to ensure the achievement of comfort and safety of the human being, and these concepts of interior design interactive, which necessitated interior designer on the revision of the common design methods in order to merge with the digital design era, where interactive design gave form and void and function new meaning, that voids became possible that there is interaction between the spaces and the human taking into account respect for internal and external environment.Where the research reviews the impact of the use of interactive design in service installations specifically in commercial establishments, by employing interactive design in the vacuum determinants (bishop, floors, walls), in order to meet the needs and requirements of users permanent development, whether social or environmental in addition to the interaction of the vacuum with the wishes of individuals .Research problem:The research problem is summarized in the scarcity of interactive design solutions in the interior design of the various spaces of public service facilities, which are largely missing from the development and improvement of internal service activities and the shortcomings in achieving the requirements and needs of users within them and achieving their well-being.research importance:The importance of the research lies in monitoring the positive aspects of interactive design for the development of spaces in public service facilities, and how to take advantage of them in developing environment-friendly future visions that meet the user's needs and improve his experience.Research goal:1. The research aims to shed light on the role of the interior designer in addressing and developing the interior spaces in public service facilities to achieve the requirements and needs of users within them interactively to improve the user experience.2. Establishing guidelines for how to provide the optimal solution in the treatment and formation of the internal void of these facilities.

Abstract Background Malnutrition including undernutrition, overnutrition, and micronutrient deficiencies are considerable problems worldwide, with variable burdens among different communities. Its complications include physical and cognitive impairment, with the probability of irreversible lifelong consequences. We aimed to assess the prevalence of undernutrition, overweight, obesity, and anemia in preschoolers, being a risk group for developmental adverse events. Methods We recruited 505 healthy preschool children, with a male: female ratio of 1.05:1. Children with chronic diseases were excluded. We used anthropometry and complete blood count to screen for malnutrition and anemia. Results The mean age of the study group was 3.8 ± 1.4 years (1.02–7). The screening results were average in 228 (45.1%) children, while 277 (54.9%) children had either abnormal anthropometry, anemia, or both. We observed undernutrition in 48 (9.5%) children; among them, 33 (6.6%) were underweight, 33 (6.6%) wasted, and 15 (3%) were stunted, with no significant difference between children aged below or above five. We identified overnutrition in 125 (24.8%); 43 (8.5%) were overweight, 12 (2.4%) were obese, and 70 (13.9%) had a high body mass index Z score, not qualifying the definition of overweight. Anemia was diagnosed in 141 (27.9%) children and was significantly more frequent among older children without gender discrimination. About 10% (50 children) had both anemia and abnormal anthropometry. The frequency of abnormal anthropometry was comparable between children with anemia and those with normal hemoglobin. Conclusion Malnutrition and anemia in preschoolers are still a heavy burden affecting about half of our study group, with an upward trend towards the overnutrition side. Anemia is still a moderate public health problem in preschoolers.

Abstract Background Malaria is a parasitic infection primarily caused by four main species of the genus Plasmodium, that is, Plasmodium falciparum, Plasmodium ovale, Plasmodium vivax, and Plasmodium malariae. It is transmitted through the bite of the female Anopheles mosquito. It holds the status of one of the leading causes of death in the developing world. Malaria is endemic to Pakistan, and the country experienced the worst floods in its history from April to October 2022. The stagnant flood water served as a breeding ground for mosquitoes, culminating in an alarming spike in malaria cases. According to the World Health Organization (WHO), the number of cases reported till August 2022 was more than in the whole year of 2021. There was more than a twofold rise in cumulative cases in 62 high‐burden Pakistani Districts in August 2022 as compared to August 2021. Aims This commentary aims to bring this emerging issue to notice and highlight the most effective probable measures to help eliminate and prevent the hazards the current outbreak poses. Results Rapid planning and execution are needed to ensure the most efficient and rapid elimination of malaria. To educate the general public, the national government must start public awareness efforts in electronic, print, and social media and deploy solar‐powered mobile healthcare units to far‐flung areas. Prophylactic and postexposure treatments should be planned because larvicidal preventive measures are less practical in flood‐affected vicinities. Conclusion The most effective preventive strategy is drug prophylaxis, followed by insecticide‐treated nets, indoor residual spraying, and untreated nets. Scientists should intensify their investigations for effective medications to alleviate the malaria burden in Pakistan.

Objectives: To investigate the incidence, types and pathophysiology of criss-cross pattern of the proximal pulmonary arteries in common arterial trunk and its influence on management and outcomes. Methods: Retrospective review of all patients with common arterial trunk who underwent Aswan Truncus Operation with regard to the origin and course of the proximal pulmonary artery branches as defined by 3D segmented models pre, immediately and 1 and 2 years after operation. Results: Between January 2019 and September 2022, 39 patients (19 males, aged 1–12 months) underwent the Aswan Truncus Operation. 18 patients (46%) had criss-cross arrangement of the proximal pulmonary artery. The mortality, ICU and hospital stay were not affected by the presence or absence of the criss-cross pattern. However, following operation in the criss-cross group, there was evidence of different degrees of kinking and twisting of the right pulmonary artery. This resulted in severe narrowing which required stenting or reoperation at different stages (1 during ICU stay and another after 1 year). Separate origin of the left pulmonary artery (Criss-cross Type 2) from a long stenotic ductus arteriosus required resection of the stenotic segment followed by anastomosis to the right pulmonary artery recreating a 60° angle of bifurcation. Conclusion: Criss-cross pattern of proximal pulmonary arteries is common in patients with common arterial trunk. Pre-operative diagnosis and tailored approaches of repair are required to prevent late complications.

Background: Nikaidoh translocation operation is increasingly being used for patients with TGA, VSD and LVOTO. The early results of this operation are excellent and possibly better than the Rastelli repair. However, the long-term results remain inadequately defined. Methods and results: Detailed follow up data of a patient, 12 years after Nikaidoh operation, using computerized image analysis are reported. The patient complained of chest pain on exertion. Imaging showed severe dilatation of the non-coronary sinus of the aortic root, compressing the RVOT and pulmonary artery branches resulting in RV dilatation. The dilated aortic sinus showed marked pulsatility with expansion during systole and diastole. As the child was symptomatic, with a risk of aneurysm rupture, excision was performed. This complication is thought to be due to interruption of the innervation of the root as well as cutting vasa vasorum. Conclusion: Nikaidoh operation is a viable solution for the repair of TGA, VSD, PS. Dilatation of the neo-aortic root should be carefully followed and causes of the dilatation investigated.

Ultra-High-Performance Concrete (UHPC) and High-Strength Concrete are the concretes with superior characteristics comparing with the normal reinforced concrete. Their compressive strength starting with 120 & 60 MPa respectively. The punching shear capacity of posttensioned (UHPC & HSC) flat slabs without non-prestressed reinforcement is experimentally investigated in this research. Five slabs with different concrete compressive strength (100, 120 & 140 MPa) and different strands layout (uniform & bundled & gapped-bundled) were tested under the effect of a monotonic concentric static load. Test results were compared with the provisions of ACI & EC2. The outcomes of the study showed that the punching shear crack occurred at the angles of about 26 & 16° for uniformly and bundled distrusted strands respectively. (HSC) slabs showed good agreement with both ACI & EC2, while (UHPC) slab exceeded the theoretical capacity by about 65%. The bundle & gapped-bundle layout slab showed a slight enhancement in the ultimate punching capacity due to improving the efficiency of used strands, but also showed major reduction in deflection, angle of shear crack and dissipated energy.

Objectives: In an attempt to enhance applicability and outcomes of corrections of common arterial trunk, we have recently described a novel method of correction based on the concept of morphodynamism, and preserving the structure of the right ventricle. The intermediate influence of this operation on right ventricular (RV) structure and function have not been described. Methods and results: Thirty eight Patients (age: 1–12 months) underwent the novel repair. There were 2 early and 4 late deaths. All patients underwent early CT scans, 12 had repeat CT and 8 had MRI after 1 year or more from the operation. Detailed computerized analysis of the RV size, shape, pattern of contraction and function was performed. The shape and size were preserved, at the second investigation, with no evidence of dilatation of the neo-RV outflow, which appeared to contribute to overall function of the RV. The directional pattern of contraction showed enhanced longitudinal and radial contributions with minimal twisting. The movement of the RV free wall and septum were almost equal, with normal shape of the septum. The instantaneous pattern of contraction followed a consistent peristalsis sequence with significant contraction of both the body and the neo-outflow. The pulmonary regurgitant fraction, at follow up, varied from 22% to 42% (30 ± 6%) with preserved RV to pulmonary artery ventriculo-arterial coupling. Conclusion: The size, shape and pattern of contraction of the RV following the novel common arterial trunk repair appears to be well preserved in the intermediate term.

Amel Awad Ibn Idris Rodwan,1 Osama Khder Ahmed Elmansour,1,2 Amar F Eldow Ahmed,3 Elnour Mohammed Elagib,1,4 Noha Ibrahim Ahmed Eltahir,4,5 Abubaker Hassan,6 Sara M El-Sadig,7 Abdel Gaffar Abdel Allah Mohammed,8 Huyam H Awadalla,9 Abubakr Abdalwahab Mohammed,5 Mohammed Elmujtba Adam Essa6,10 1Department of Rheumatology, Sudan Medical Specialization Council, Khartoum, Sudan; 2Department of Rheumatology, Faculty of Medicine, Shendi University, Shendi, Sudan; 3Department of Internal Medicine, Wayne State University, Detroit, MI, USA; 4Department of Rheumatology, Omdurman Military Hospital, Khartoum, Sudan; 5Department of Medicine, Faculty of Medicine, Karary University, Khartoum, Sudan; 6Department of Clinical Medicine, Medical and Cancer Research Institute, Nyala, Sudan; 7Department of Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan; 8Rheumatology Department, Security Forces Hospital, Makkah, Saudi Arabia; 9Department of Internal Medicine, Detroit Medical Centre, Detroit, MI, USA; 10Faculty of Medicine, Al Fashir University, Al Fashir, SudanCorrespondence: Mohammed Elmujtba Adam EssaDepartment of Clinical Medicine, Medical and Cancer Research Institute, Nyala, SudanTel +249-90-700-938Email Awadali818@yahoo.comAbstract: Thrombotic thrombocytopenic purpura (TTP) is an uncommon life-threatening condition characterized by hemolytic disorders. The coexistence of systemic lupus erythematosus (SLE) with TTP is extremely rare, although Africans are at increased risk due to inherited risk factors. This report describes a rare clinical manifestation of TTP associated with SLE in a Sudanese patient. A 41-year-old Sudanese woman presented to the emergency department with symptoms and features that were suggestive of malaria, for which she had been treated accordingly. However, a few days later she complained of fever, and was found to have a body temperature of 39.5°C, jaundice, anemia, and thrombocytopenia. Soon after admission, she developed confusion and unrecordable blood pressure. After the patient had stabilized, clinical assessment, immune-system investigation (antinuclear antibody profile, complements, blood panel), and imaging revealed a diagnosis of TTP associated with SLE. The patient received imipenem 500 mg, five sessions of plasmapheresis (60 mL/kg), methylprednisolone 1 g pulse for 3 days, and rituximab 375 mg/week. Three weeks later, the patient was discharged after her condition had improved, and she is now on regular follow-up.Keywords: TTP, SLE, African female, rituximab and plasmapheresis

Abstract Background Open reduction internal fixation (ORIF) is the gold standard management of fractures of the distal humerus. Stable fixation to allow early mobilization is not always possible in cases with comminuted fracture patterns and bone loss, with a high failure rate. We propose augmentation of internal fixation in these unstable situations with a spanning plate across the elbow to protect the fixation construct temporarily until bone union. Methods Eighteen patients with complex distal humeral fractures were managed with standard ORIF technique augmented with a temporary plate spanning across the elbow as an internal fixator. Cases included were either very distal, comminuted (6 cases) or insufficiency fractures (4 cases) or revision fixation cases (8 cases). The temporary spanning plate was removed as soon as signs of early radiographic union were detected. Results Seventeen patients were available for final follow up at a mean 28.3 months. The spanning plate was removed after 3.4 months on average. At the final follow-up, the mean elbow total arc of motion was 86.3°. The mean Mayo Elbow Performance Score (MEPS) was 80, and the mean Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score was 27. Conclusion Spanning the elbow temporarily with a plate in adjunct to standard ORIF technique is both simple and effective in achieving fracture stability and union and minimizes failure rates after fixation of comminuted, very distal fractures, osteoporotic cases, or revision fixation cases with bone loss. Level of evidence Level IV, Therapeutic study

Abstract Protonic ceramic fuel cells (PCFCs) have become the most efficient, clean and cost-effective electrochemical energy conversion devices in recent years. While significant progress has been made in developing proton conducting electrolyte materials, mechanical strength and durability still need to be improved for efficient applications. We report that adding 5 mol% Zn to the Y-doped barium cerate-zirconate perovskite electrolyte material can significantly improve the sintering properties, mechanical strength, durability and performance. Using same proton conducting material in anodes, electrolytes and cathodes to make a strong structural backbone shows clear advantages in mechanical strength over other arrangements with different materials. Rietveld analysis of the X-ray and neutron diffraction data of BaCe0.7Zr0.1Y0.15Zn0.05O3−δ (BCZYZn05) revealed a pure orthorhombic structure belonging to the Pbnm space group. Structural and electrochemical analyses indicate highly dense and high proton conductivity at intermediate temperature (400–700 °C). The anode-supported single cell, NiO-BCZYZn05|BCZYZn05|BSCF-BCZYZn05, demonstrates a peak power density of 872 mW cm−2 at 700 °C which is one of the highest power density in an all-protonic solid oxide fuel cell. This observation represents an important step towards commercially viable SOFC technology.

Abstract Background This studies the influence of algae and coated urea fertilization on the productivity of some leguminous crops in order to reach the best methods of fertilization to get on highest productivity in sandy soils. Results The results proved that both yield and its components a better result in the focus of the SCU + algae than utilizing sulfur-coated fertilizers and algae in both seasons. A large amount extreme yield and straw yield were established with the algae treatment. The outcomes uncovered that SCU + algae improved plant productivity and quality soybean and mungbean seeds. The utilization of SCU + algae expanded protein, carbohydrates and oil %, compared with sulfur-coated urea and algae. Conclusion Along these lines, it could be finished from the results that of SCU + algae with 60 kg N/fed observed to be the best portion to accomplish or gain with exertion the greatest quality.

Background and Aim: Helicobacter species infections have epidemiological and zoonotic impacts, and different species of Helicobacter have been implicated in infecting humans and animals. The aim of this study was to investigate Helicobacter species infections in Camelus dromedarius. Materials and Methods: Fecal samples were collected from 32 camels from 9 camel farms located at Ismailia Governorate, Egypt. The collected samples were investigated by bacteriological isolation and conventional polymerase chain reaction (PCR) assays targeting the 16S ribosomal RNA gene. Results: Although Helicobacter species could not be isolated from all the examined samples, Helicobacter DNA was detected in 2 (22.22%) of the 9 camel farms. Of the 32 camel fecal samples examined, 4 (12.5%) were positive for Helicobacter species as analyzed by the PCR assay. Conclusion: To the best of our knowledge, this is the first report of PCR-based detection of Helicobacter species infections in C. dromedarius. Further epidemiological studies are required to clarify Helicobacter species infections in camels.

Brain cancer is one of the most dominant causes of cancer death; the best way to diagnose and treat brain tumors is to screen early. Magnetic Resonance Imaging (MRI) is commonly used for brain tumor diagnosis; however, it is a challenging problem to achieve higher accuracy and performance, which is a vital problem in most of the previously presented automated medical diagnosis. In this paper, we propose a Hybrid Two-Track U-Net(HTTU-Net) architecture for brain tumor segmentation. This architecture leverages the use of Leaky Relu activation and batch normalization. It includes two tracks; each one has a different number of layers and utilizes a different kernel size. Then, we merge these two tracks to generate the final segmentation. We use the focal loss, and generalized Dice (GDL), loss functions to address the problem of class imbalance. The proposed segmentation method was evaluated on the BraTS'2018 datasets and obtained a mean Dice similarity coefficient of 0.865 for the whole tumor region, 0.808 for the core region and 0.745 for the enhancement region and a median Dice similarity coefficient of 0.883, 0.895, and 0.815 for the whole tumor, core and enhancing region, respectively. The proposed HTTU-Net architecture is sufficient for the segmentation of brain tumors and achieves highly accurate results. Other quantitative and qualitative evaluations are discussed, along with the paper. It confirms that our results are very comparable expert human-level performance and could help experts to decrease the time of diagnostic.

Rheumatic heart disease is a serious ailment with significant morbidity and mortality in endemic areas; yet, there is no agreement on indication, timing, and surgical modality for treating rheumatic valve affection. There is mounting evidence that rheumatic mitral valve repair is possible with good long-term results, less is the case with rheumatic aortic valve disease. We discuss the surgical approach for both valves emphasizing the role of multimodality imaging.

Rheumatic heart disease (RHD) is the most common cause of acquired heart disease in children and young adults. It continues to be prevalent in many low- and middle-income countries where it causes significant morbidity and mortality. Following the 2017 Cairo conference “Rheumatic Heart Disease: from Molecules to the Global Community,” experts from 21 countries formulated an approach for addressing the problem of RHD: “The Cairo Accord on Rheumatic Heart Disease.” The Accord attempts to set policy priorities for the eradication of acute rheumatic fever (ARF) and RHD and builds on a recent series of policy initiatives and calls to action. We present an update on the recommendations of the Cairo Accord and discuss recent progress toward the eradication of RHD, including contributions from our own Aswan Rheumatic Heart Disease Registry (ARGI).

Background: We aim to assess the predictive value of serum neuron-specific enolase (NSE) level in patients with acute ischemic stroke referring to the emergency department. Methods: This systematic review and meta-analysis performed, considering the PRISMA and MOOSE statement guidelines. A computerized literature search of the known medical database conducted by using the relevant keywords. We included studies published before November 2016 in which stroke patients compared with non-stroke controls and also studies evaluating the serum levels of NSE in the study groups. Statistical analysis was pooled in a random effect model analysis using the Comprehensive Meta-Analysis software. Results: We included 12 articles in the qualitative and quantitative analysis, that their quality acceptable based on the Newcastle Ottawa Scale (NOS scale). The pooled effect estimates showed that NSE is significantly higher in ischemic stroke patients in comparison with their controls with a high effect estimate [OR 9.68, 95% CI (3.06 to 30.6)]. The effect estimate remained statistically significant under the fixed and random effects model. Conclusion: Our results show higher levels of NSE in patients with stroke than in the control group, indicating that NSE plays a role in the diagnosis of stroke. In terms of prognosis, there is evidence regarding the direct and indirect relationship; and it founded that serum levels of NSE is higher in larger stroke volume, which needs further research.

Blockchain is the underlying technology of a number of digital cryptocurrencies. Blockchain is a chain of blocks that store information with digital signatures in a decentralized and distributed network. The features of blockchain, including decentralization, immutability, transparency and auditability, make transactions more secure and tamper proof. Apart from cryptocurrency, blockchain technology can be used in financial and social services, risk management, healthcare facilities, and so on. A number of research studies focus on the opportunity that blockchain provides in various application domains. This paper presents a comparative study of the tradeoffs of blockchain and also explains the taxonomy and architecture of blockchain, provides a comparison among different consensus mechanisms and discusses challenges, including scalability, privacy, interoperability, energy consumption and regulatory issues. In addition, this paper also notes the future scope of blockchain technology.

Objective: To develop a new sandwich based lateral flow immunochromatographic strip for rapid detection of circulating Schistosoma mansoni antigen in serum and urine samples of patients with active schistosomiasis. Methods: This lateral flow immunochromatographic strip was prepared by using anti-Schistosoma mansoni soluble egg antigen monoclonal antibody conjugated gold nanoparticles (MAb-AuNPs) as antigen-detecting antibody, while crystalline material (MCM)-41-MAb bioconjugate was immobilized at the test line as antigen-capturing antibody. Both antigen capturing and detecting antibodies formed sandwich complexes with circulating Schistosoma mansoni antigen in the positive samples. Sandwich complexes immobilized at the test line gave distinct red color. The assay reliability was examined by using urine and serum samples of 60 Schistosoma mansoni infected patients, 20 patients infected with parasites other than Schistosoma, and 20 healthy individuals as negative controls. Results were compared with those obtained via sandwich enzyme linked immunosorbent assay (ELISA). Results: The detection limit of circulating Schistosoma mansoni antigen by lateral flow immunochromatographic strip was lower (3 ng/mL) than the detection limit by ELISA (30 ng/mL). The sensitivity and specificity of lateral flow immunochromatographic strip in urine samples were 98.3% and 97.5%, respectively compared to 93.5% and 90.0% by ELISA. In serum samples, they were 100.0% and 97.5%, respectively compared to 97.0% and 95.0% by ELISA. The strip test took approximately 10 min to complete. Conclusions: This new lateral flow immunochromatographic strip offers a sensitive, rapid, and field applicable technique for diagnosis of active schistosomiasis.

We are pleased to present this Special Issue of Cells, entitled ‘Feature Papers in Stem Cells’ [...]

The new compositions of BaCe0.5Zr0.3Y0.15-xYbxZn0.05O3-δ perovskite electrolytes (x = 0.1 and 0.15) were prepared by solid state synthesis and final sintering at 1500 °C. The obtained ceramics were investigated using X-ray diffraction, scanning electron microscopy, thermo-gravimetric analysis and impedance spectroscopy. The refinement of XRD data confirmed cubic crystal structure with Pm3m space group for both samples. SEM morphology showed larger and compacted grains which enables obtaining of high density and high protonic conductivity. The relative densities of the samples were about 99% of the theoretical density after sintering at 1500 °C. The protonic conductivities at 650 °C were 2.8×10-4 S/cm and 4.2×10-3 S/cm for x = 0.1 and 0.15, respectively. The obtained results showed that higher Yb-content increases the ionic conductivity and both of these perovskites are promising electrolyte for intermediate temperature solid oxide fuel cells to get high efficiency, long-term stability and relatively low cost energy system.

Herein, we aimed to identify the immunomodulatory role of tumor Syndecan-1 (CD138) in the polarization of CD4+ T helper (Th) subsets isolated from the tumor microenvironment of inflammatory breast cancer (IBC) and non-IBC patients. Lymphocytes and mononuclear cells isolated from the axillary tributaries of non-IBC and IBC patients during modified radical mastectomy were either stimulated with the secretome as indirect co-culture or directly co-cultured with control and Syndecan-1-silenced SUM-149 IBC cells. In addition, peripheral blood mononuclear cells (PBMCs) of normal subjects were used for the direct co-culture. Employing flow cytometry, we analyzed the expression of the intracellular IFN-γ, IL-4, IL-17, and Foxp3 markers as readout for basal and co-cultured Th1, Th2, Th17, and Treg CD4+ subsets, respectively. Our data revealed that IBC displayed a lower basal frequency of Th1 and Th2 subsets than non-IBC. Syndecan-1-silenced SUM-149 cells significantly upregulated only Treg subset polarization of normal subjects relative to controls. However, Syndecan-1 silencing significantly enhanced the polarization of Th17 and Treg subsets of non-IBC under both direct and indirect conditions and induced only Th1 subset polarization under indirect conditions compared to control. Interestingly, qPCR revealed that there was a negative correlation between Syndecan-1 and each of IL-4, IL-17, and Foxp3 mRNA expression in carcinoma tissues of IBC and that the correlation was reversed in non-IBC. Mechanistically, Syndecan-1 knockdown in SUM-149 cells promoted Th17 cell expansion via upregulation of IL-23 and the Notch ligand DLL4. Overall, this study indicates a low frequency of the circulating antitumor Th1 subset in IBC and suggests that tumor Syndecan-1 silencing enhances ex vivo polarization of CD4+ Th17 and Treg cells of non-IBC, whereby Th17 polarization is possibly mediated via upregulation of IL-23 and DLL4. These findings suggest the immunoregulatory role of tumor Syndecan-1 expression in Th cell polarization that may have therapeutic implications for breast cancer.

Minimally invasive surgery is widely used because of its tremendous benefits to the patient. However, there are some challenges that surgeons face in this type of surgery, the most important of which is the narrow field of view. Therefore, we propose an approach to expand the field of view for minimally invasive surgery to enhance surgeons’ experience. It combines multiple views in real-time to produce a dynamic expanded view. The proposed approach extends the monocular Oriented features from an accelerated segment test and Rotated Binary robust independent elementary features—Simultaneous Localization And Mapping (ORB-SLAM) to work with a multi-camera setup. The ORB-SLAM’s three parallel threads, namely tracking, mapping and loop closing, are performed for each camera and new threads are added to calculate the relative cameras’ pose and to construct the expanded view. A new algorithm for estimating the optimal inter-camera correspondence matrix from a set of corresponding 3D map points is presented. This optimal transformation is then used to produce the final view. The proposed approach was evaluated using both human models and in vivo data. The evaluation results of the proposed correspondence matrix estimation algorithm prove its ability to reduce the error and to produce an accurate transformation. The results also show that when other approaches fail, the proposed approach can produce an expanded view. In this work, a real-time dynamic field-of-view expansion approach that can work in all situations regardless of images’ overlap is proposed. It outperforms the previous approaches and can also work at 21 fps.

The recent Coronavirus Disease 2019 (COVID-19) pandemic has put a tremendous burden on global health systems. Medical practitioners are under great pressure for reliable screening of suspected cases employing adjunct diagnostic tools to standard point-of-care testing methodology. Chest X-rays (CXRs) are appearing as a prospective diagnostic tool with easy-to-acquire, low-cost and less cross-contamination risk features. Artificial intelligence (AI)-attributed CXR evaluation has shown great potential for distinguishing COVID-19-induced pneumonia from other associated clinical instances. However, one of the associated challenges with diagnostic imaging-based modeling is incorrect feature attribution, which leads the model to learn misguiding disease patterns, causing wrong predictions. Here, we demonstrate an effective deep learning-based methodology to mitigate the problem, thereby allowing the classification algorithm to learn from relevant features. The proposed deep-learning framework consists of an ensemble of convolutional neural network (CNN) models focusing on both global and local pathological features from CXR lung images, while the latter is extracted using a multi-instance learning scheme and a local attention mechanism. An inspection of a series of backbone CNN models using global and local features, and an ensemble of both features, trained from high-quality CXR images of 1311 patients, further augmented for achieving the symmetry in class distribution, to localize lung pathological features followed by the classification of COVID-19 and other related pneumonia, shows that a DenseNet161 architecture outperforms all other models, as evaluated on an independent test set of 159 patients with confirmed cases. Specifically, an ensemble of DenseNet161 models with global and local attention-based features achieve an average balanced accuracy of 91.2%, average precision of 92.4%, and F1-score of 91.9% in a multi-label classification framework comprising COVID-19, pneumonia, and control classes. The DenseNet161 ensembles were also found to be statistically significant from all other models in a comprehensive statistical analysis. The current study demonstrated that the proposed deep learning-based algorithm can accurately identify the COVID-19-related pneumonia in CXR images, along with differentiating non-COVID-19-associated pneumonia with high specificity, by effectively alleviating the incorrect feature attribution problem, and exploiting an enhanced feature descriptor.

Automated identification of plant diseases is very important for crop protection. Most automated approaches aim to build classification models based on leaf or fruit images. These approaches usually require the collection and annotation of many images, which is difficult and costly process especially in the case of new or rare diseases. Therefore, in this study, we developed and evaluated several methods for identifying plant diseases with little data. Convolutional Neural Networks (CNNs) are used due to their superior ability to transfer learning. Three CNN architectures (ResNet18, ResNet34, and ResNet50) were used to build two baseline models, a Triplet network and a deep adversarial Metric Learning (DAML) approach. These approaches were trained from a large source domain dataset and then tuned to identify new diseases from few images, ranging from 5 to 50 images per disease. The proposed approaches were also evaluated in the case of identifying the disease and plant species together or only if the disease was identified, regardless of the affected plant. The evaluation results demonstrated that a baseline model trained with a large set of source field images can be adapted to classify new diseases from a small number of images. It can also take advantage of the availability of a larger number of images. In addition, by comparing it with metric learning methods, we found that baseline model has better transferability when the source domain images differ from the target domain images significantly or are captured in different conditions. It achieved an accuracy of 99% when the shift from source domain to target domain was small and 81% when that shift was large and outperformed all other competitive approaches.

In this paper, Modified-Dynamic Resource Allocation Management Algorithm is implemented in macrocell network. Previously, the algorithm was developed for heterogeneous network with both smallcell and macrocell network. The increasing number of network nodes in wireless cellular communication has increased the demand of proper resource allocation in heterogeneous network. Inter-cell interference is still considered as one of the most challenging issues in vast deployment of mobile base stations in urban and sub-urban areas. In LTE and LTE-A network, spectrum sharing and leasing mandated by huge number of base stations (indoor and outdoor) deployed, has an adverse effect on systems throughput and quality of service. Advances in resource management strategies has improved the interference scenarios in vast scale. A modified dynamic resource allocation management algorithm for macrocell network is proposed here to counter the intercell interference. Simulation environment is developed to study the performance of M-DRAMA for the marcoell network. The performance analysis shows that higher number of users get quality coverage at high node density.

Contents A 10-year-old, clinically healthy, male dromedary camel had presented a history of progressive unilateral testicular enlargement over the past 5 years. The animal had mated with 32 females during that period; all had conceived. The sex ratio of his offspring was one male to 31 females. Ultrasound examination of the right testicle revealed a diffusely heterogeneous parenchyma with no identifiable normal testicular tissue. The enlarged testicle was surgically removed. Macroscopically, the testicle had a glistening pink surface and contained multiple soft, bulging nodules. Histopathologically, a well-differentiated, diffuse seminoma was diagnosed. In conclusion, this study describes the fertility, sex ratio, clinical findings and ultrasonographic imaging in a male dromedary camel affected with unilateral testicular seminoma. [ABSTRACT FROM AUTHOR]

The application of computer interfaced controlling devices is increasingly rapidly in modern age. Analogous wired systems are substituted by computer interfaced system alternatives in growingnumber of industries. Such control systems had been developed with complex and critical high-end stuffs. In this paper, we developed an automated system that controls the switching of electric feeder power supply featuring the existing GSM technology. The target is tooperate the device according to a preset sequence of on-off mode for three feeders after a particular time interval and to monitor the running condition. The device sends short message updating the status of every action. It also warns the consumers about load shedding using GSM module via sending message. Controlling the gate pulse of a MOSFET that operates the relay, it executes on-off operation of the circuit breaker of the respective feeders. Since GSM technology is used worldwide for communication, third world countries that are still struggling to meet the power demand can use this technology to operate and monitor the condition of power distribution. To operate the GSM device, AT command of GSM location operation for SIM900 is used. This paper targets to improve the power distribution system in developing countries like India, Bangladesh, Nepal where powercrisis and load shedding is quite a common phenomenon.

Final 5-year results of the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial were recently presented at the Transcatheter Cardiovascular Therapeutics (TCT) and European Society of Thoracic Surgery (ESTS) meetings. SYNTAX is frequently quoted as “the most important percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) trial in multivessel and/or left main (LM) coronary artery disease (CAD) conducted to date”. However, the impact of its findings on day-to-day clinical practice remains surprisingly humble.

This study presents the design and stress analysis of mobile robot switchover module (track tensioner), which helps the robot to work in hybrid locomotion mechanism. The track tensioner is a loading and unloading module that helps the locomotion system transformability while robot moves either on wheel or track mechanism. The selection of suitable material for its design, the model is therefore analysed under static loading. It was analysed under static load of 200 N on two selected materials Aluminium alloys Al6061-T6 and Al7075-T6, to determine its mechanical behaviour of models. The results concluded that the material Aluminium alloy Al7075-T6 would be more suitable material for robot design as compared to Aluminium alloy Al6061-T6.

Venous aneurysms are relatively rare anomalies which can affect different parts of the vascular system. Diagnosis and management of this condition could pose important problems. We here report a giant false aneurysm of the subclavian vein with emphasis on the thought process that determined the management strategy.