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Background: Young adults, especially those under 35, are often overlooked; however, previous studies have shown that coronary artery disease (CAD) incidence increases rapidly. Previous studies proved many risk factors for CAD, such as hyperlipidemia, hypertension, diabetes, and smoking. The present study ultimately aimed to figure out the correlation between Hyperuricemia (HUA) and smoking in CAD Patients under the age of 35. Methods: This observational study included 100 young adults (18–35 years of age) suspected of CAD. We used the Gensini Score system to ascertain coronary angiography outcome and CAD; based on the number of affected vessels, localization of the segment, and the stenosis grade. The Gensini score being > 0 indicated the presence of CAD. Results: In young adults under 35, there was a significant correlation between HUA and CAD. The interaction between HUA and smoking had a contrast for CAD that statistically shown the existence of CAD increased in patients who have hyperuricemia and non-smokers compared to smokers. Conclusions: By monitoring various parameters in young adults ≤ 35 years old. This study strengthens the correlation between:1) hyperuricemia and the occurrence of CAD, 2) Smoking and the CAD. Furthermore, there is a clear association between HUA and the occurrence of CAD in non-smokers.

Obesity is an independent risk factor for cardiovascular diseases. Coronary artery calcium (CAC) is a direct measure of coronary atherosclerosis. The study investigated the effect of bariatric surgery on CAC scores in people with severe obesity subjected to laparoscopic sleeve gastrectomy (LSG). This prospective study included 129 people with severe obesity in two groups; the LSG group (n=74) subjected to surgery and the diet group (n=55), managed by a diet regimen and lifestyle modification. Cardiovascular risk was assessed by Framingham risk score (FRS) and coronary calcium score (CCS) measured by computed tomography initially and after 3 years. The two groups had a comparable CAD risk before treatment according to FRS or CCS. After treatment, CCS improved significantly in the LSG group (p=0.008) but not in the diet group (p=0.149). There was no correlation between FRS and CCS (r=0.005, p=0.952). Treatment resulted in significant weight reduction and improved fasting blood glucose and lipid profile in the two groups. The change of weight, blood glucose, and HDL, and remission of diabetes mellitus (DM) were significantly higher in the LSG group compared to the diet group. LSG may reduce the risk of developing future cardiovascular comorbidities evidenced by reducing CAC scores. Significant weight reduction and improvement of cardiovascular risk factors may recommend LSG as a cardioprotective procedure in people with severe obesity.

Background: Anastomosis of gastrointestinal tract more commonly used in most of abdominal operations including esophagus, stomach, small intestine, large intestine, and biliary system. However single layer versus double layer anastomotic technique is still a matter of discussion as regard safety and efficacy. Objective: To study efficacy and safety of single layer intestinal anastomosis against double layer anastomosis as regard leakage, cost effectiveness, and the time of the procedure. Patients and methods: This prospective randomized study included 40 patients requiring small intestinal resection and anastomosis at Al- Hussein University Hospital and Damanhur Medical National Institute (Al-Behira) during the period between May 2019 and October 2020. The cases of this study were subjected to full history taking, full clinical examination, along with routine laboratory and radiological investigations. The cases of this study were divided into two equal groups randomly; Group A was subjected to one-layer anastomosis, and group B underwent double layered anastomosis. All cases were subjected to the standard post-operative care. Oral intake and hospital stay were recorded. In addition, post-operative complications including leakage, ileus, and mortality were recorded. Results: Mean time of operation in the single layer intestinal anastomosis was statistically significantly shorter as compared with double layered intestinal anastomosis (28.29 ± 8.15 minutes and 35.19 ± 9.96 minutes) respectively. The early postoperative findings and late postoperative complications were comparable in both groups with no statistically significant difference. Conclusion: Single layer intestinal anastomosis was less time consuming, less utilization of packing material, in addition to equal efficacy and safety as compared with double layer intestinal anastomosis.

Parkinson's disease (PD) is the second most common neurodegenerative disorder disease right after Alzheimer's and the most common movement disorder for elderly people. It is characterized as a progressive loss of muscle control, which leads to trembling characterized by uncontrollable shaking, or (tremors) in different parts of the body. In recent years, deep learning (DL) models achieved significant progress in automatic speech recognition, however, limited studies addressed the problem of distinguishing people with PD for further clinical diagnosis. In this paper, an approach for the early detection of patients with PD using speech features was proposed, a recurrent neural network (RNN) with long short-term memory (LSTM) is applied with the batch normalization layer and adaptive moment estimation (ADAM) optimization algorithm used after the network hidden layers to improve the classification performance. The proposed approach is applied with 2 benchmark datasets of speech features for patients with PD and healthy control subjects. The proposed approach achieved an accuracy of 95.8% and MCC=92.04% for the testing dataset. In future work, we aim to increase the voice features that will be worked on and consider using handwriting kinematic features.

Obesity is a chronic condition that affects millions globally; consequently, bariatric surgery is the key to this serious issue. Bariatric procedures are rapidly expanding in number and methods to address the recognized problems. So, it would make a sense for surgeons and patients if there is a more physiological bypass surgery technique in Morbid obesity. This study aims to evaluate the outcome proposed technique.The present study is a retrospective analysis on 256 participants subjected to the proposed bypass procedure from December 1999 to January 2017, the participants were followed up for an interval of 3years.The findings of the present study revealed a significant Excess Weight Loss (EWL). In addition, patients experienced decreased calcium, iron, vitamin B12, Hemoglobin, zinc, and Prothrombin Concentration. However, three to six months after surgery, they experienced a significant improvement until they reached normal levels without any supplement by the end of 12,18 months, with a three-year follow-up.This proposed Bypass Operation aims to adequate digestions as well as selective absorption without inducing any vital deficit. Most of study's population showed no elements inadequacies, although few percentages emerged during the interval of maximal weight reduction, and it were transient and minimal. No minerals or vitamins were needed.

Using Health personal protective equipment (PPE) such as face masks, safety foot shoes and protective suits has expanded dramatically due to COVID-19 pandemic leading to a widespread distribution of the PPE, particularly the face masks, in the environments including streets, dump sites, seashores and other risky locations. The environmental degradation of polypropylene, the essential plastic component in single-use face masks (SUM), takes between 20 and 30 years and thus it is essential to develop experimental approaches to recycle the polypropylene or to reuse it in different ways. This paper explores the integration of SUM into concrete structures to improve its mechanical properties. We first to cut the inner nose wire and ear loops, then distribute the PPE material among five different mixed styles. The PPE were applied by volume at 0%, 1%, 1.5%, 2.0%, and 2.5%, with tests focusing on UCS, STS, FS, and PV to determine the concrete's overall consistency and assess the improvement in its mechanical properties. The results showed that adding PPE improves the strength properties and general performance of the concrete specimens. The pattern of rising intensity started to fade after 2%. The findings demonstrated that adding PPE fibers enhanced the UCS by 9.4% at the optimum 2% PPE. The PPE fibers, on the other side, are crucial in calculating the STS and FS of the reinforcement concrete.

Background: Hypotension is commonly occurred with Spinal anesthesia. Colloids and Crystalloids are used preoperatively to prevent hypotension. Objective: To examine the effect of fluid (crystalloid vs. colloid) preloading on hemodynamic stability in old patients planned for lower limb orthopedic operations with spinal anesthesia. Patients and methods: Eighty patients undergoing orthopedic surgery under spinal anesthesia were included in this work. Their age ranged between 60-80 years. Patients were allocated randomly to either Crystalloid (Ringer solution RS group) or Colloid (hydroxyethyl starch solution HES group). Intravenous preload of 10 mL/kg of either lactated Ringer's solution in the RS group or hydroxyethyl starch solution (6% HES 130/0.4; Voluven) in the HES group was infused over 20 min before spinal anesthesia.. Hemodynamic parameters were recorded, and all results were compared. Results: More than 20% drop in systolic blood pressure occurred in 45% patients in the crystalloid group compared to 15% patients in the colloid group. This difference was significant statistically (p < 0.01). Regarding requirement of ephedrine to treat hypotension, (45% of patients in crystalloid group required Ephedrine compared to 15% patients in colloid group). This was also statistically significant (p < 0.01). Conclusion: Colloid solution was better than crystalloid solution in controlling blood pressure, ephedrine requirements and heart rate changes.

The repair of inguinal hernia is still one of the most prevalent surgical procedures done worldwide. Among all repair techniques, open Lichtenstein repair is the most globally conducted. In the past few decades, laparoscopic technique for inguinal hernia repair has increased technical demand.The current work is a short-term study to make a comparison between open Lichtenstein repair of inguinal hernia as well as laparoscopicThe present prospective randomized study recruited 100 male subjects from General Surgery Department of Al-Azhar University Hospitals and Ain Shams university hospitals suffering from oblique inguinal hernia (unilateral non recurrent hernia) with an age above 18 years and good overall health, who were randomized into two groups: Group A: 49 cases were subjected to laparoscopicThis study detected less post-operative pain day 0, day 1, day 7 and 1 month postoperatively. There was no significant difference at 6 months post-operatively.Finally, we concluded that TAPP repair for inguinal hernia (unilateral non recurrent hernia) safer with less early post-operative pain. Also, it has fewer complications, with a significantly longer operative time.

Introduction and Aim: Obesity is characterized by low-grade inflammation, which is depicted by an increase of proinflammatory cytokines and a decrease of anti-inflammatory cytokines. This study was...

The improvement in the physico-mechanical properties of lime–silica fume (SF) pastes through the incorporation of nano-metakaolin (NMK) was investigated. Lime–SF paste (1 : 1 by weight) was prepared as a reference binder. To examine the influence of NMK on strength development, SF was replaced with 2–10 wt% NMK. The compressive strength, capillary water absorption and pore structure of the designed mixes were determined after 3, 7 and 28 d of curing. X-ray diffraction analysis and differential scanning calorimetry were used to study the phase composition and scanning electron microscopy (SEM) was used for microstructural investigations. The lime–SF binder modified with 6% NMK exhibited the best mechanical performance. Pore structure analysis confirmed that NMK provided significant refinement in the pore structure of the blended pastes and SEM micrographs revealed noticeable microstructural improvements. The capillary water absorption coefficient decreased considerably with an increase in NMK content up to 6% compared with the reference mixture. Use of the developed lime–SF–NMK paste is recommended as a promising innovative binder for specific cement applications such as plastering and renovation of buildings.

Introduction: Obesity is a complex disease with multiple aspects that is associated with different health comorbidities including obstructive sleep apnea (OSA). The aim of this study is to evaluate...

This study critically analyzes changes in land use and land cover by means of multi-temporal remote sensing of Najran City in Saudi Arabia between 1975 and 2019. A number of remotely sensed data were employed to create multi-maps using: (a) the normalized difference vegetation index; (b) head-up digitizing; and (c) supervised classification of Landsat images using field observation and accuracy assessment, including field verification and Google Earth Professional. Criteria from a well-known technique of environmental assessment, the Building Research Establishment Environmental Assessment Method (BREEAM), were used to critically analyze land use and evaluate levels of sustainability, with particular focus on ecology. Therefore, land around Najran can be characterized as follows: (1) Najran valley; (2) agricultural land; (3) built-up areas; (4) reclaimed land; (5) basement rock; and (6) desert. The results indicate that agricultural land grew from an average of 39.81 km2 (1.07%) in 1975 to 218.51 km2 (5.9%) in 2005, although this was followed by a marked decline between 2005 and 2019. Urban land increased from 1.12 km2 (0.031%) in 1975 to 154.35 km2 (4.13%) in 2019. Furthermore, there was approximately 1289.47 km2 of reclaimed land in 1975 (i.e., 34.64% of the total area study area) but approximately 1151.1 km2 (30.86%) in 2019. There was a small amount of desert (i.e., sand dunes) in the study area, and no change was recorded in the basement rock. This study analyzed these land changes, likening them to BREEAM criteria of ecology and land use. A number of unsustainable practices were potentially resulting in serious land contamination and pollution of both surface and ground water, as well as an increased risk of flooding.

Background Atelectasis can result during general anesthesia from mechanical ventilation and decrease in lung volume particularly in morbidly obese patients undergoing abdominal laparoscopic sleeve surgery, which may result in the development of postoperative pulmonary complications (PPCs), including hypoxemia and pneumonia, with an increased risk of postoperative morbidity and mortality. Objective To compare between volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) in prevention of postoperative pulmonary atelectasis in morbidly obese patients undergoing laparoscopic gastric sleeve surgery. Methods This is a randomized prospective comparative clinical study with a total of 52 morbidly obese patients who were randomly divided into 2 groups; 26 patients in group (V) for VCV and 26 in group (P) for PCV arterial blood samples were obtained, and PaCO2, PaO2, and SaO2 were obtained and recorded. ABG analyses were also obtained 30 min, 12 h, and 24 h post-extubation, and PaCO2, PaO2, and SaO2 were obtained and recorded. Results The results of this study revealed no significant differences between PCV and VCV as regards the incidence of postoperative lung atelectasis immediately postoperative (69.2% with VCV vs 61.5% with PCV, p = 0.368), 12 h postoperative (61.5% with VCV vs 53.8% with PCV, p = 0.282), and 24 h postoperative (53.8% with VCV vs 46.2% with PCV, p = 0.325). There were also no significant differences between VCV and PCV as regards baseline, intra-, and post-operative PaCO2 levels as well as baseline and postoperative SaO2 and PaO2 values. However, PCV showed better intraoperative oxygenation compared to VCV. SaO2 was 96.32% ± 1.85 and 97.25% ± 1.37 in VCV and PCV groups respectively (p = 0.027) while PaO2 was 212.75 mmHg ± 20.13 and 225.8 mmHg ± 18.69 in VCV and PCV groups respectively (p = 0.011). Conclusion Despite a slight improvement in intraoperative oxygenation parameters (PO2, SaO2) with PCV than VCV, there is no significant difference between VCV and PCV in the prevention of postoperative pulmonary atelectasis; moreover, there is no difference in postoperative oxygenation parameters in morbidly obese patients who undergo laparoscopic sleeve surgery.

Weight reduction can effectively improve nonalcoholic fatty liver disease (NAFLD), which is a constant companion of severe obesity. This study aimed to determine the effect of one-anastomosis gastric bypass (OAGB) on pathological liver changes in severely obese cases with NAFLD.The present prospective research comprised 67 subjects with morbid obesity scheduled for OAGB during the period from February 2015 to August 2018. Clinical, biological, and histologic data were evaluated pre and 15 months postoperatively.Fifteen months after surgery, a considerable reduction was noted in the grades of fat deposition, liver cell ballooning, and lobular inflammatory changes, in addition to the total NAS score. Fifteen months after surgery, nonalcoholic steatohepatitis (NASH) disappeared in 42% of the patients. A significant regression of fibrosis stage occurred after surgery in 79.1% of patients (p0.001). After surgery, patients had substantial reductions in aspartate aminotransferase, alanine aminotransferase, γ-glutamyltransferase, HbA1c, total cholesterol, and Low-density lipoprotein (p0.001, for all comparisons). Diabetes mellitus, hypertension, and dyslipidemia resolved in 54%, 59%, and 69% of the patients, respectively.OAGB resolved NASH from nearly 42% of patients and reduced the histological features of NAFLD 15 months after surgery. Bariatric procedures might be adopted as a therapeutic modality in severely obese cases with NAFLD after the failure of lifestyle modifications.

As quality soils become scarce and their location is more difficult and expensive, it becomes increasingly necessary to improve soil quality through soil stabilization. The benefits of energy saving and resource conservation, effective recycling of all solid wastes (fly ash, slag, lime, marble dust, etc.) has become a global concern that requires research and development. This article presents the results of a laboratory tests to investigate the effects of marble powder and lime on compaction characteristics, Atterberg limits, shear strength parameters, and unconfined compression test of two Algerian soils. Marble powder and lime are added in varying percentages (2%, 4%, and 6% by weight) to the soil samples. Test results reveal that the liquid limit and plasticity index decrease, whereas the plastic limit increases with the addition of lime and marble powder for soil A and soil B, in which the decrease is more significant with soil A than soil B. The unconfined compressive strength increased with increasing curing time and percentages of lime and marble powder for the two soils. The highest unconfined compressive strength was achieved at 6% marble powder for soil B after 28 days. The addition of marble powder for both soils decreased the optimum moisture content and increased the corresponding maximum dry unit weight. However with lime addition, both soils show decrease in the optimum moisture content and in the corresponding maximum dry unit weight. The shear strength parameters increased for both soils with increase of lime percentages. Whereas for the addition of marble powder, there is an increase of friction angle and decrease of cohesion for soil A. There is considerable change for soil B with marble powder, a decrease in friction angle and an increase in cohesion. The results show that marble powder could be used as a stabilizer for soils with high clay content and known mineralogy composition. In addition, it is very important to get rid of its negative effect on environment and to obtain economical benefit from it.

BACKGROUND & AIM Bariatric surgery is a valid treatment option for persons with non-alcoholic fatty liver disease. This study prospectively examined the impact of laparoscopic sleeve gastrectomy (LSG) on liver histopathology, and blood levels of adiponectin, leptin, resistin, and pre-B cell enhancing factor/Nampt/visfatin. PATIENTS & METHODS In 81 patients with non-alcoholic fatty liver disease who underwent LSG, paired liver biopsies and blood specimens were obtained before and 18 months after LSG. Differences between preoperative and 18 months postoperative data were tested by paired Student's t-test or Wilcoxon rank test as appropriate. RESULTS At follow up, there was a significant improvement in biochemical markers for glucose homeostasis, including fasting glucose, HbA1c, insulin levels, and homeostatic model assessment index. Postoperative liver function tests, namely serum alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transpeptidase level, showed a significant improvement compared to before weight loss. The number of patients who had definite, borderline, or no non-alcoholic steatohepatitis was 43 (53%), 27 (33%), and 11 (14%), respectively, at baseline, and 9 (11%), 32 (40%), and 40 (49%) at 18-month post-surgery follow up. A significant reduction in steatosis, liver fibrosis, lobular inflammation, and hepatocyte ballooning was observed in the postoperative biopsies (P