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Abstract Introduction Kuwait has a large expatriate community who experience both restricted access to public health services and lower income than Kuwaiti citizens. Given these conditions, we examined differences in characteristics and management of chronic kidney disease (CKD) between Kuwaitis and expatriates. Methods Clinical and laboratory data for adult CKD Stages 3–5 not on dialysis (CKD 3–5 ND) patients with native kidneys attending nephrology clinics in all Ministry of Health hospitals collected from January 1, 2022, to December 31, 2022. Cohort was then divided into Kuwaiti patients and expatriates patients for comparison. Results We collected data from 2,610 patients (eGFR: 30.8 ml/min/1.73m2; age: 62.6 years; males: 56.7%; Kuwaitis: 62.1%). Kuwaitis were older (63.94 vs. 60.3 years, p

Abstract Background: Total hip arthroplasty (THA) by using ceramic-on-ceramic (CoC) implants has emerged as a promising solution to mitigate wear debris-related complications, such as osteolysis, specifically in younger patients. This study aims to investigate the functional outcomes after total hip replacement by CoC in patients less than 30 years old, conducted within the hospitals of Khartoum, Sudan. Methods: A descriptive, cross-sectional, hospital-based study was carried out across the major healthcare institutions in Khartoum state from October 2021 to April 2022. A cohort of 32 patients, all aged 30 or below, who underwent total hip replacement were included. Thorough data analysis was conducted using advanced statistical techniques. Results: The average age of included patients was 25.69 ± 2.7 years, among them, males had a slight predominance (56.3%) with a male-to-female ratio of 1.3:1. Most patients had a secondary school level of education (37.5%), while workers constituted the largest group (34.4%). The included patients were followed-up for more than six months. The mean visual analog scale (VAS) score was 7.91 ± 0.893. Additionally, the mean modified Harris hip score was 83.03 ± 4.9 (range: 72–91), highlighting the enhanced hip function achieved through the procedure. The majority of patients (65.6%) reported good functional outcomes, followed by 28.1% who attained fair outcomes and 25.8% who reported excellent outcomes. Conclusion: The study demonstrates that CoC THA yields optimal functional outcomes among patients aged 30 years and below. The procedure exhibits remarkable potential to improve hip function and alleviate pain in this specific patient population. These findings highlight the efficacy and viability of CoC implants in younger patients, contributing to the advancement of hip arthroplasty techniques.

Subsidence in southeastern Louisiana is a significant geological issue caused by natural and human-induced factors like low-lying topography and groundwater pumping. Human activities also led to coastal land loss and reduced sediment supply. Satellite-based technologies such as Global Navigation Satellite Systems (GNSS) and Interferometric Synthetic Aperture Radar (InSAR) are used to monitor subsidence. Louisiana has about 130 continuously operating reference stations (CORS) monitoring subsidence statewide. GNSS provides accurate point measurements but limited spatial coverage. InSAR, however, detects ground deformation over large areas using satellite-based radar imagery. In response to this advantage, we employed Sentinel-1 SAR images from 2017 to 2021 to estimate the vertical displacement in East Baton Rouge (EBR) Parish. Significant displacement is found in urban and industrial areas, particularly in high- and medium-density residential areas. The significant subsidence area is between Denham Spring and Baton Rouge faults, where residential areas experience displacement of -0.7 to -1 cm/year. The displacement variation in land use indicates significant annual subsidence in some buildings and infrastructure. Three strategic facilities in Baton Rouge Downtown experienced displacement, with -6.1 mm/yr in Downtown, -2.99 mm/yr at Horace Wilkinson Bridge, and -4.94 mm/yr at central railway station. In addition, machine learning is employed to estimate the vertical displacement in the study area. The K-Nearest Neighbors (KNN) model provides a comprehensive understanding of subsidence estimation among the GBR (Gradient Boosting Regression), RFR (Random Forest Regression), and KNN models. Machine learning models revealed that proximity to fault lines and precipitation are the most influential factors in displacement.

Abstract Background: Attention deficit hyperactivity disorder, which is a prevalent neurodevelopmental condition, commonly manifests during early childhood and has the potential to adversely affect an individual's social, academic, and occupational performance in multiple settings. Students with ADHD may struggle with attention, focus, listening, and completing schoolwork. Additionally, they may exhibit restless or disruptive behavior in class and may have learning disabilities that affect their academic performance. The aim of this study was to explore the perspectives of primary school teachers on ADHD in Alkadrow, Khartoum, Sudan. Methods: A descriptive cross-sectional study was conducted in Alkadrow-Bahri locality, Sudan, over a period of three to six months in 2022. The study population included primary school teachers who had taught for at least one year and encountered at least one student with ADHD. A convenience sampling technique was used to select a minimum of 59 participants, and data were collected using a self-administered questionnaire with closed-ended questions. SPSS version 23 was used to analyze the data, including descriptive statistics and inferential statistics such as chi-square tests and logistic regression analysis. Results: The study had 59 participants, with the majority being female and in the age group of 41–45 years. The participants were mostly married and had obtained psychology courses, with a bachelor's degree being the most common level of education. Many participants had over 20 years of teaching experience. Regarding the attitude toward attention deficit hyperactivity, most participants strongly agreed that they did have a negative/positive attitude toward it, and a majority agreed or were neutral toward ADHD. However, in the case of attention deficit hyperactivity, a significant percentage of participants disagreed or strongly disagreed with the statement. Conclusion: The study found that most participants had a negative attitude toward student referrals for medical care and believed that most symptoms of ADHD can be lowered by aging. Additionally, more than half strongly disagreed that punishment has a positive effect on ADHD.

ABSTRACTBackground Supraglottic Airway Devices (SGAs) are designed to counteract the drawbacks of endotracheal intubation. They have proven to be easy to use, robust, versatile, and usable in many difficult situations. This work aims to investigate the use of the Baska Mask (BM) airway and ProSeal™ Laryngeal Mask Airway (PLMA) as SGAs for ventilation.Methods This randomized controlled trial was carried out on 74 cases aged 21–65 years old for elective surgery of a planned duration of up to 2 h during general anaesthesia with intermittent positive pressure ventilation. Cases were divided into two equal groups. Ventilation was done either by BM® Airway (group BM) or PLMA (group PLMA).Results BM had a shorter insertion time and lower leak fraction versus PLMA, while seal pressure elevated significantly with BM versus PLMA (P

ABSTRACTBackground Transesophageal Doppler (TED) is a minimally invasive monitor that allows continuous hemodynamic variables monitoring. Non-invasive electrical cardiometry (EC) and TED methods added an additional facility to monitor cardiac output (CO) continuously and guide fluid management. The aim of this study was to correlate hemodynamic monitoring between non-invasive EC and Esophageal Doppler (ED) in cases undergoing major abdominal surgery.Methods This prospective observational study was carried out on 35 adult cases, American Society of Anesthesiologists (ASA) physical status II or III, undergoing major abdominal surgery. Esophageal Doppler and EC were attached to the same patient. Parameters measured were hemodynamic parameters.Results Comparison of CO with ICON and ED showed that the ICON mean value ranged from 5.6 to 6.2 l/min, and the ED mean value always ranged from 5.7 to 7.6 l/min with the non-significant difference between the two methods. The precision for the ICON ranged from 15.19 to 17.99% and the precision for ED ranged from 13.39 to 17.08%. At a 15% change in ICON, the ED values’ sensitivity was 72.6% and specificity was 30.9% with AUC 0.505.Conclusion The agreement between CO measured by EC and ED is acceptable. Both monitored trend changes and guided fluid administration in the operation theater. The EC is as accurate as ED in measuring hemodynamics during major abdominal surgery.

Synthetic Aperture Radar (SAR) data processing evolving from level-0 raw data is complicated, especially in data decoding, manifesting in obtaining a well-focused SAR image. This paper is intended to present a complete MATLAB-based SAR data processing tool, which helps the end-user to treat simply the steps of image generation. This paper would enrich the research community in the field of SAR processors, especially in the area of understanding, handling, and developing a SAR processor based on space packet protocol standard (STD 01) used in many SAR systems such as Sentinel-1, ERS-1, CubeL, JPSS-2, 3, and 4. Also, this work opens the door for researchers to decode other space packet protocol standards and even to create an algorithm based on fully understanding the image formation algorithm from its roots. Moreover, the work in this paper could be a stepping-stone for the beginner in the field of SAR signal processing to become familiarized with SAR image generation procedures. The level-0 raw data used in this paper is based on Sentinel 1 SAR satellite obtained from the European Space Agency Copernicus website, a free open-source for level-0 and level-1 data types. The MATLAB program allows users to compare their generated image with the level-1 single-look complex (S1-L1-SLC) image utilizing entropy, contrast, and sharpness image quality metrics.The results showed that the images produced by the proposed algorithm are comparable to Sentinel-1 level-1 SAR images for the same scene and achieved satisfactory accuracy under the requirements for image quality.

Abstract Background Percutaneous vertebroplasty and percutaneous kyphoplasty are effective minimally invasive procedures in reducing pain and improving the quality of life in patients with osteoporotic vertebral compression fractures with different degrees, but it may lead to serious neurological complications. Results Twenty-five patients were included in our study. Both techniques were done under local anesthesia using bi-pedicular approach. All cases were assessed using plain radiographs pre- and post-operative, Visual Analogue Scale for pain, and modified Oswestry Disability Index for functional disability. Thirteen patients had vertebroplasty and 12 patients had kyphoplasty. The mean age for vertebroplasty group was 66.94 ± 6.71, while in kyphoplasty group, the mean age was 70.38 ± 9.21. In vertebroplasty group, there were ten females and three males, while in kyphoplasty group, there were nine females and three males. All cases had single vertebral level affection except one patient in the vertebroplasty group that had double-level affection. In vertebroplasty group, ten patients had lumbar spine affection, two patients had dorsal spine affection and one patient had combined dorsal and lumbar spine affection. In kyphoplasty group, ten patients had lumbar spine affection and two patients had dorsal spine affection. The mean post-operative Visual Analogue Scale was 0.46 and 0.50 in vertebroplasty and kyphoplasty groups, respectively. The mean post-operative modified Oswestry Disability Index became 4.15 and 4 in vertebroplasty and kyphoplasty groups, respectively. The mean post-operative local kyphotic angle was 6.0° and 6.50° in vertebroplasty and kyphoplasty groups, respectively. The mean vertebral height became 73.15% and 75% post-operatively in vertebroplasty and kyphoplasty groups, respectively. The intra-operative cement leakage occurred in three cases of vertebroplasty group and one case of kyphoplasty group (P = 0.644). The cost of kyphoplasty was very high in comparison with vertebroplasty. Conclusions There is no difference between vertebroplasty and kyphoplasty as regard pain relief, improved quality of life, correction of kyphotic angle, vertebral height restoration and the incidence of cement leakage except that kyphoplasty has a very high cost than vertebroplasty. Therefore, both techniques have an equal effect in treating osteoporotic vertebral compression fractures.

This study was aimed to investigate the effects of petroleum waste in wastewater and local environment in Melut and Maban Counties in South Sudan. Population of the study is 30,000 people. 265 respondents were selected randomly as a sample of the study. Variables were, wastewater status of citizen, health and effects on the local environment. Data were collected through survey, involving (primary data) which were collected by using questionnaire and (laboratory data) which were collected from waste water in three locations. (SPSS) was used for primary data analysis by using descriptive statistics, while for the laboratory data, Atomic absorption Spectroscopy (AAS700) was used for detecting Hg, As, Pb, Fe and Mn elements levels in wastewater samples. Findings of the primary data showed 94.1% of residents’ respondents noticed the decrease of rains in the study area and 65.9% of them noticed the decrease of temperature. 86.2% of public health employees respondents reported defections of newly born children, 93.8% of them reported infant’s mortality. 90.8% of them reported infertility infections. 75.4% of them reported eyes and skin allergy infections and 66.2% of them reported teeth decay and hair falling infections. 67.7% of the national resource’s employees’ respondents noticed animals drink the wastewater and 83.1% of them reported the death of birds around the petroleum pits. while the laboratory data indicates presence of (Hg, As and Pb) in higher levels compared to the normal international allowed one in wastewater, and the level of (Fe and Mn) were lower. Recommendations are includes avoiding using wastewater near the petroleum wells, treatment of the wastewater for human and animals using and Petroleum companies must abide to the rules of the petroleum work and they have to contribute in the development of local community and awareness.

Abstract Background: Hemodialysis procedures is considered as a supportive management for kidney failure. Nurses play a major role in hemodialysis procedures, because most of the complications facing patients during dialysis as hypotension, cramped muscles, and weak pulse, need nurses with knowledge and practical experience. The current study aimed to assess nurses' knowledge and practice about hemodialysis procedures. Methods: This is a cross-sectional study, which included 103 nurses who worked in dialysis centers in Khartoum State in Sudan, from February to May 2022. A self-administered questionnaire and observational checklists were used to collect the data and was analyzed using the statistical program for social science (SPSS) version 23, the knowledge and practice score was calculated, and the mean was obtained. Results: The results of our study showed the mean scores of the participant knowledge 11.3, and practice 13.6, and also showed statistical significance regarding the relationship between the level of education and knowledge of nurses regarding hemodialysis procedure; p-value = 0.01. Conclusion: The study concluded that there is sufficient knowledge and practice of nurses in dialysis centers, and there is also a relationship between educational level and knowledge, so the study recommends conducting continuous training for nurses in dialysis centers.

Synthetic aperture radar (SAR) is considered a prevailing tool for remote sensing. It benefits working with high efficiency in all weather and all-day circumstances, making SAR is very confident compared to other types of remote sensing. The SAR platform moves with constant velocity and height, with a linear path for ideal situations. However, this assumption is not realized in satellite movement, which is an elliptical orbiting that worsens the quality of the focused image. This paper introduces a methodology of motion compensation for motion errors due to satellite elliptical orbiting and perturbations in an orbital path. It represents two major contributions applied on a low earth orbit (LEO) spaceborne SAR. First, motion errors analysis in the range and azimuth directions. Second, an algorithm for motion error compensation (MOCO) combined with a chirp scaling algorithm (CSA) is performed. Moreover, a validation for the formulated algorithm is executed using sentinel-1 level-0 real raw data input, and the result is compared with the sentinel-1 level-1 single look complex (SLC) SAR image. The validation is performed using two different metrics. First, image quality measurement by sharpness, contrast, and entropy. Second, measuring the peak-sidelobe-ratio (PSLR), impulse-response-width (IRW), and integrated-sidelobe-ratio (ISLR) for five high power reflecting points in the scene area.

Background: Anti-Vascular Endothelial Growth Factor (Anti-VEGF) therapy serves to decrease central retinal thickness in eyes affected with diabetic macular edema (DME). The Retinal Nerve Fiber Layer (RNFL) forms the basis of the optic nerve. Objectives: Our study is concerned with studying the effects of Anti-VEGF injections in patients with DME on RNFL thickness. Patients and methods: This was a prospective cohort interventional study conducted at South Valley University Hospital, Ophthalmology department outpatient clinic. It included 50 diabetic patients with diabetic macular edema whose RNFL thickness was measured before the anti-VEGF injections and again after the completion of the three injections treatment course using spectral domain optical coherence tomography (SD-OCT). Results: This study included 50 eyes from 50 patients. 35 (70%) of them were females and 15 (30%) of them were males. 26 patients (52%) had their right eye injected, and 24 patient (48%) had their left eye injected. The superior quadrant of the RNFL showed a mean increase of 1.2 microns (SD = 38.4, 95% Confidence Interval CI = -9.7:12.1, p value = 0.829). The inferior quadrant showed a mean increase of 7.5 microns (SD = 35.6, 95% CI = -2.6:17.6, p value = 0.144). The nasal quadrant showed a mean increase of 8.3 microns (SD = 23, 95% CI = 1.8:14.9, p value = 0.014). The temporal quadrant showed a mean increase of 4.1 microns (SD = 33.2, 95% CI = -5.3:13.6, p value = 0.386). Conclusion: There is no statistically significant correlation between intra-vitreal injections of anti-VEGF and the RNFL thickness.

BackgroundSmoking is a common problem in university students worldwide. Smoking is one of the most dangerous social phenomena and has a significant impact on public health. This study investigated the beliefs and attitudes of medical students toward smoking in Sudan.MethodsA cross-sectional study was conducted among medical students at Al Neelain University, Sudan, from March to June 2022 using a web-based questionnaire. The questionnaire consisted of eight items on demographic characteristics and 13 on the beliefs and attitudes toward smoking. Other data included smoking status, smoking habits, the number of cigarettes smoked per day, and smoking duration. Data analysis was performed descriptively, and chi-square test and logistic regression were conducted using SPSS version 24. Statistical significance was set at 0.05.ResultsA total of 336 students participated in this study, and the smoking prevalence was 48.8% (41.1% in men and 7.7% in women). In total, 76.8% reported smoking daily at a rate of 5–10 cigarettes per day. In terms of students’ beliefs about smoking, 86.8% disagreed with selling cigarettes at the university. Of the respondents, 68.4% did not approve smoking on campus. There was a relationship between smoking habits and the age group of 22–25 years, which was the highest smoking category among students (p-value = 0.01).ConclusionThe prevalence of cigarette smoking among medical students is disturbing, particularly as they are future doctors. There is a need to include plans to reduce smoking among students that can be incorporated into courses and special programs.

Abstract Background PRAETORIAN is the first randomized controlled trial that demonstrated the noninferiority of subcutaneous ICD (S‐ICD) in comparison with transvenous ICD (TV‐ICD). We retrospectively reviewed electronic records of patients with ICD implanted over the past 6 years, with the primary objective to compare our real‐world single tertiary center experience with the randomized data from the PRAETORIAN study. Methods Seventy S‐ICD patients were compared with 197 TV‐ICD patients, from July 2014 to June 2020 retrospectively, over a median period of 1304 days (296–2451 days). Primary composite endpoints included inappropriate shocks and device‐related malfunctions. Results Patients with S‐ICD implantation were younger than those who received TV‐ICD (mean, 49.7 years vs 63.9 years, p

The main objective of this paper is to provide a thorough analysis of currently used modulation control schemes for single-phase bidirectional dual active bridge DC/DC converters. In this article, it will be shown that single phase shift, extended phase shift and dual phase shift modulation schemes are special cases of the triple phase shift (TPS) modulation scheme. The article aims to highlight six TPS switching modes and their complements with operational constraints. Unlike previous studies that regarded TPS as a complex scheme, this paper simplifies the analysis of each mode and aims to standardize the understanding of TPS modulation for dual active bridge (DAB) converters. Power equations, range of power transferred and zero-voltage switching (ZVS) are derived for all the modes under TPS without assuming fundamental component analysis. Additionally, a generic optimization algorithm is developed to show the advantages of TPS modulation, and thus, the analysis in this paper offers a valuable insight for single-phase DAB converter designers in identifying a wide range of optimization algorithms to achieve higher efficiency under TPS modulation. This analysis contributes to the advancement of bidirectional DAB converter technology and facilitates its application in various power electronic systems.

A 35-year-old pregnant female in her second trimester presented with heart failure manifestations with evidence of very severe fixed left ventricular outflow tract obstruction. The peak systolic gradient was 132 mmHg, which is the highest reported in the literature, secondary to congenital subaortic membrane. Similar case reports that we could find in the literature were reviewed to highlight the importance of such anomaly.

Objective The purpose of this study was to perform hematological and molecular analyses of the HbS allele of the hemoglobin subunit beta gene in the Sudanese population. Methods This was a descriptive cross-sectional study. Hematological parameters and fetal hemoglobin (HbF) levels were assessed in all participants. Data were gathered through the use of questionnaires and laboratory investigations. The β S -globin haplotypes, S allele distributions, and hematological parameters with HbF levels were investigated using PCR-restriction fragment length polymorphism, gel electrophoresis, and a Sysmex hematology analyzer, respectively. Results According to our findings, the Bantu (BA) haplotype was found in 10.8% of participants with homozygous uncontested haplotypes, followed by Benin (BA) and Sudan (SU), each in 9.8% of participants. This Sudanese group from Northern Kordofan lacked the Arab-Indian haplotype. Two heterozygous versions of undisputed haplotypes were found in 17.3% of participants: SU/BA in 10.8% and CA/BE in 6.5%. Conclusion As a result of sickle cell anemia, this investigation found changes in hematological parameters. In the Sudanese population, a new haplotype of the S gene was discovered.

Most of the approximately 105 million Egyptians depend on wheat in the form of baladi bread for their daily diet. Millions of smallholders along the River Nile have produced wheat for millennia; however, in more recent history, the wheat demand and supply ratio has dramatically changed. The first wheat imports in Egyptian history were in 1966. Today, domestic production meets only half of the wheat consumption, and Egypt has become the largest wheat importer in the world. Before the Russia–Ukraine war, 85% of the wheat imports to Egypt came from Russia and Ukraine. The war and the associated disruption of the wheat supply chains has put Egypt on the top list of so-called “developing countries highly threatened by food crises”. Against this backdrop, we analyzed decision-making factors and perceptions of wheat-producing smallholders in the Nile River Delta, the wheat basket of Egypt. The study draws on nine months of empirical fieldwork in the Nile River Delta. We employed a mixed approach to data collection, combining interviews and focus group discussions with smallholders, experts, and agriculture extension agents with transect walks and field observations. In total, 246 randomly selected wheat-growing smallholders were interviewed in four divisions in the Nile River Delta. Our findings show that the production of wheat by smallholders is highly influenced by system-immanent factors, such as subsistence need for home consumption and the presence and intensity of animal husbandry, as well as by external factors, such as the domestic prices for wheat determined by the government in each season and the time of the declaration of these prices. These factors affect smallholders’ decisions to increase or decrease their wheat cultivation area. However, the study also showed that the factors influencing farmers’ decisions to grow wheat or implement innovative practices vary across different areas within the same region. Smallholders struggle with poor access to fundamental production factors and are discontented with the low provision of extension and support services as well as poor market structures. These constraints act as disincentives for smallholders to produce (more) wheat. They need to be addressed and eliminated to increase domestic production and to reduce Egypt’s dependency on expensive and unreliable wheat imports.

Summary: Background: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p

Background: The continuous rise in the number of patients suffering from Helicobacter pylori is probably due to the changes in modern life. Nowadays, patients suffering from gastrointestinal problems are diagnosed through invasive and non-invasive techniques. The choice of a diagnostic test is influenced by factors such as the tests' sensitivity and specificity, the clinical conditions, and the cost-effectiveness of the testing strategy. This study aimed to compare molecular detection methods of H. pylori by polymerase chain reaction (PCR) targeting the 16S rRNA, ureA and glmM genes with an invasive histopathological technique. Methods: 290 gastric biopsies were collected using gastrointestinal endoscopy from patients with gastritis symptoms in different hospitals in Khartoum state. Two gastric biopsies were collected from each patient for PCR and histopathology. Results: A total of 103 (35.5%) samples were positive by histopathological examination, 88 (30.3%) by 16S rRNA, 39 (13.4%) by glmM gene, and 56 (19.3%) by ureA gene. The highest sensitivity was observed in 16S rRNA (46.6%), followed by glmM (24.3%) and ureA (23.3%). While the best specificity was observed in glmM gene (92.5%), followed by ureA (82.3%) and 16S rRNA (78.6%). Conclusion: PCR test targeting the 16S rRNA gene exhibited the best results for molecular detection of H. pylori compared to other genes.

Previous studies show promising effects of some standard fly ash classes on asphalt. However, there is limited research into off-spec fly ash. Multiple studies published presented fly ash as unique compared to traditional mineral fillers. In this paper, several coal combustion wastes (CCW) are examined in terms of their physio-chemical interaction with asphalt binders. Eight types of CCW are blended with two types of asphalt binders: unmodified and polymer modified (PMA). The physical properties and chemical composition of the CCW are characterized. Testing is focused on identifying changes in binder performance after blending with the CCW to understand the role of the CCW. The experimental program is focused on damage healing, rheological performance, and Low-temperature cracking potential. All the blends are conditioned using the pressure aging vessel. Oxidative aging is quantified through measurement of both carbonyl (ICO) and sulfoxide (ISO) indices by Fourier-Transform Infrared Spectroscopy (FTIR). Results show that some of the CCWs are associated with improved rheological performance, damage healing, and cracking resistance. The improvement is attributed to the level of interaction between the binder and the CCW and the physical and chemical characteristics of the CCW. Testing results demonstrate that synergy between the CCW particles and polymer modifiers needs further investigation. Statistical regression analysis is used to quantify the level of significance of influencing factors on the blend performance. The analysis revealed that the level of interaction between the CCW and the binder is measurable by the phase angle of the blend. The CCW’s silicon (Si), Sulfur (S) content, along with particle size distribution and specific gravity, are the significant chemical and physical properties influencing the blend performance. These findings propose a fruitful upcycling opportunity for some CCW as an enhancer of asphalt performance.

Patients with Muir-Torre Syndrome (MTS) are at increased risk of developing sebaceous carcinomas besides other visceral malignancies. Pembrolizumab is an effective therapy in patients with high microsatellite instability (MSI-H)/mismatch repair deficient (dMMR) tumors. We report a 70-year-old Caucasian man with a diagnosis of MTS who had multiple sebaceous carcinomas. Molecular profiling and immunohistochemical staining of the tumor cells revealed MSI-H/dMMR and high tumor mutational burden (TMB). He did not have evidence of metastatic disease. Following multiple failed local therapies to the left upper eyelid disease, he was treated with four doses of pembrolizumab which resulted in a complete resolution of the lesion. This case shows that Pembrolizumab can provide a complete response in MTS patients with MSI-H/dMMR sebaceous carcinoma. Although promising, this needs to be further validated in clinical trials.

In Egypt, recent shortfalls in the wheat supply from Russia and Ukraine have necessitated substantial increases in domestic production. As agricultural practices influence the yield of bread wheat, we assessed current production strategies in the wheat-based systems of Egypt and investigated their effects on wheat productivity in four study areas in the Nile Delta. We used a multi-stage random sampling technique to select 246 wheat-producing farmers and applied structured questionnaires to assess farming practices and crop performance attributes. Data were analyzed by using descriptive statistics, analysis of variances, and multiple regression models. Wheat farmers were on average 56 years old with about 30 years of farming experience. Land holdings were rather small, with an average of 1.05 hectares and a mean wheat yield of 6.4 metric tons (t)/hectare (ha). Farmers devote 5 times per season. Most farmers had poor knowledge of modern agronomic practices and inadequate access to information. To enhance domestic production in Egypt, there is a need for fiscal incentives, permitting or stimulating wheat-producing farmers to devote larger shares of their cropland to wheat cultivation. In addition, policies must enable wheat producers to improve their productivity by implementing adequate and sustainable agricultural practices such as crop rotations, balanced mineral nutrient supply, and the use of organic amendments. However, the most important factors are interventions and technologies that improve provision and increase the use efficiency of irrigation water.

ABSTRACTBackground: This study aims to investigate the analgesic efficacy of ketamine and neostigmine as adjuvants to local anesthetic in ultrasound-guided Serratus anterior plane block for patients undergoing Modified Radical Mastectomy.Methods: Ninety female patients aged 20–65 who were scheduled for a modified radical mastectomy under-combined general anesthesia and preoperative Serratus Anterior Plane Block were included. Three local anaesthetic mixtures were used, either 30 ml bupivacaine 0.25% + 1 ml ketamine (50 mg) (Group K) or 30 ml bupivacaine 0.25% + 1 ml neostigmine (500 μg) (Group N) or 30 ml bupivacaine 0.25% + 1 ml normal saline (Group S). The first 24 hours of postoperative morphine consumption was set as the primary outcomeResults: the 24 hr postoperative morphine consumption median was 3.0 (0.0–9.0) for group (S), 1.5 (0.0–4.0) for group (N) and 0.0 (0.0–4.0) mg for group (K) with statistical significant (P value 0.045). The first postoperative analgesic request was insignificant between group (K), group (N) and group (S) was (6.14 ± 5.17), (6.67 ± 3.18) and (5.89 ± 4.4 hr), respectively. The Intraoperative Fentanyl consumption showed a significant reduction in group (N) and group (K) (111.67 ± 30.64 and 110.00 ± 20.34, respectively) compared to group (S) (131.67 ± 42.51 μg). The numerical rating scale did not differ between study groups except at 8th and 16th hrs. Postoperatively.Conclusion: The addition of 50 mg ketamine to 0.25% bupivacaine during preoperative ultrasound-guided SAPB combined with GA in female patients undergoing modified radical mastectomy decreased the 24 hr postoperative morphine consumption and the intraoperative fentanyl requirements while adding 500 µg neostigmine decreased the intraoperative fentanyl requirements.Clinical trial registration: The study was registered at clinicaltrials.gov (NCT 04544228).

ABSTRACTBackground Formerly management of malignant tumors of lower limb was mainly through amputation. After advancement in neoadjuvant chemo-radiotherapy, saving the limb through lower limb-sparing surgery became the main line for management. Different regional techniques are used for perioperative pain control in limb-sparing surgeries. One of these techniques is lumbar paravertebral block. It is a regional technique that provides ipsilateral analgesia resulting in somatic and sympathetic blockade in a continuous dermatomal manner.Methods The study included 60 cancer patients scheduled for lower limb sparing surgeries. Patients were randomly allocated into two groups to receive either lumbar paravertebral block Group P with 25 ml of Bupivacaine 0.25%, with adrenaline 1:200,000 or general anesthesia Group C.Results There was a statistically significant decrease in hemodynamics values for Group P compared to Group C at most of the study times. Intraoperative fentanyl consumption was lower in Group P compared to Group C (107.1 ± 22.89 ug versus 233.43 ± 49.29 ug), respectively. VAS scores were lower for Group P compared to Group C with lower postoperative morphine consumption in Group P compared to Group C (8.65 ± 3.57 mg versus 16 ± 3.15 mg) respectively.Conclusion Ultrasound guided paravertebral block can be used as an effective perioperative analgesic modality for cancer patients undergoing lower limb sparing surgeries.

ABSTRACTBackground To compare the analgesic effects of thoracic paravertebral block versus lidocaine infusion for management of post-thoracotomy pain.Methods 60 patients who were scheduled for thoracotomy were randomly divided into two equal groups: IV group received 1.5 mg/kg of 1% lidocaine over 10 min then infusion of 1.5 mg/kg/h, and thoracic paravertebral group (PVB) received 10 ml lidocaine 1% over 30 s then infusion of 1.5 mg/kg/h through catheter was inserted under ultrasound guidance. Hemodynamic and respiratory variables, frequency and duration of postoperative mechanical ventilation, duration of ICU stay, time till start of respiratory exercise and till chest tube removal, analgesia was assessed using 100-point visual analogue scale and defined as VAS

ABSTRACTBackground: The control of postoperative pain following major lumbar spine surgeries remains a major challenge for anesthesiologists, and many new strategies and methods have been developed for pain control. This study’s main objective was to evaluate the efficacy of the bilateral ultrasound-guided erector spinae plane block (US-ESPB) as a method for perioperative pain management in patients undergoing lumbar spine surgeries.Methods: This double-blinded prospective randomised controlled study was conducted on 140 patients aged between 18 and 65 years; all were scheduled for elective lumbar spine surgeries. Patients were randomly allocated into one of the two groups: the ESPB group (n = 70) or the control group (n = 70). All patients received bilateral US-ESPB after induction of general anaesthesia, in the ESPB group; 20 mL of levobupivacaine 0.25% were used, while 20 mL normal saline was given to the control group instead. The primary endpoint was the total amount of morphine consumed during the intraoperative and the first 24 postoperative hours. Secondary endpoints included, time to first request of rescue analgesia as well as incidence of adverse effects.Results: The total amount of morphine consumed during the intraoperative and the first 24 postoperative hours was found to be significantly lower in the ESPB group compared to the control group (P

Abstract The modern process of new drug discovery and development is an exciting, yet a challenging, endeavor. Although it can result in significant financial income and meet the medical needs of patients, it ultimately may result in failure. To achieve a fast and successful new product discovery and development process, natural products which are evolutionarily optimized as drug-like molecules have gained great attention as better potential sources of new chemical entities. Historically, plant species containing berberine are used in various traditional phytotherapy. However, despite the various therapeutic effects it exerts, berberine is not yet developed into a drug product. Addressing the barriers that hinder its successful development and the efforts made to overcome them is thus crucial. The toxicological and pharmacokinetic properties of berberine are the main barriers towards its development into a marketed drug product. It has low aqueous solubility, poor absorption, fast metabolism, and wide tissue distribution which lead to low bioavailability limiting its clinical application. Synthetic berberine derivatives with improved properties are suggested as better alternatives for further development and future therapeutic application. Hence, this paper summarizes the preclinical research studies conducted in the last decade to reveal the therapeutic potential of synthetic berberine derivatives for the treatment of various diseases and hence achieve successful berberine-based drug development in the future. To exploit the value of natural products as a source of leads for the development of effective drugs, collaboration among the different discovery and development scientists is essential.

Background Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation and respiratory symptoms. Several diseases co-exist with COPD. Tobacco smoking is an important risk factor for comorbidities. Comorbidities potentiate the morbidity and the mortality of COPD. Aim of the work The aim of this study was to study the different comorbidities in COPD patients and assess their impact on COPD patients. Patients and methods This is an observational cohort study carried out at El-Mahalla El-Kobra Chest Hospital on 188 COPD patients between June 2018 and June 2019. All patients underwent spirometry, categorized into spirometric severity grades and ABCD GOLD groups according to GOLD 2019. Demographics data, smoking index, BMI, comorbidities, and the presence of dyspnea were collected. The Charlson Comorbidity Index was calculated. Results One hundred eighty-eight patients were analyzed. 69.68% of the participants were men; the mean age was 57.5 years. More than 70% of the patients had severe and very severe COPD. More than 70% of the patients were GOLD C and GOLD D. More than 95% of the studied patients had different comorbidities and the most frequent comorbidities were hypertension (54.78%), diabetes mellitus (36.70%), anemia (28.72%), gastroesophageal reflux disease (17.02%), ischemic heart disease (11.17%), and arrhythmia (10.36%). There was a significant difference among the ABCD GOLD groups in age, smoking index, Charlson Comorbidity Index, and the prevalence of anemia and gastroesophageal reflux disease. Conclusions COPD patients had different comorbidities, which have a negative impact on the severity of the disease.

Egypt is the largest wheat importer in the world; however, it produces only half of the 20 million tons of wheat that it consumes annually. The population of Egypt is currently growing by 1.94% per year, and projections predict that the demand for wheat will be nearly doubled by 2050. Russia and Ukraine are major wheat exporters to Egypt and globally, shipping grains from ports in the Black Sea. The ongoing conflict aggravates the already precarious food security situation in Egypt and many other import-dependent countries in Africa and Asia by disrupting supplies and accelerating food price hikes. Wheat is a strategic commodity in Egypt. Its production is a question of political stability. Against this backdrop, the Egyptian government declared gaining wheat self-sufficiency as a strategic aim. This study provides an overview of the degree and trends of cultivated wheat area, yield, production, and wheat self-sufficiency in Egypt between 2000 and 2020, followed by a qualitative analysis determining external pressures and system-immanent drivers that had an impact on wheat self-sufficiency in the past two decades in view of predicting future pathways to achieve wheat self-sufficiency in a sustainable way. The study underlines some critical external pressures such as agricultural policies, (subsidized) production inputs, climate conditions, global wheat supply chains, and system-immanent drivers such as domestic wheat supply prices and yields influencing the area of wheat cultivation and its productivity. There is a significant need to implement more effective and long-term sustainable agricultural policies in order to make wheat production in Egypt (more) attractive and feasible for smallholders again.

Abstract Objectives To evaluate analgesic and hemodynamic outcome of fentanyl or midazolam as additives to local anesthetic mixture (LAM) for peribulbar block (PBB) during posterior chamber surgery. Methods One hundred thirty-two ASA status I to III adult patients aged 50–75 years scheduled for posterior segment surgery (intraocular foreign body and elective vitrectomy) were enrolled in this prospective, randomized, double-blind trial from which 12 patients were excluded. After signing a written fully informed consent for study participation, patients were grouped into 3 groups (40 patients in each group); group C received local anesthetic mixture plus 1 ml plain saline, group F received local anesthetic mixture plus 25 μg fentanyl in 1 ml saline and group M received local anesthetic mixture plus 1 mg midazolam in 1 ml saline. The primary outcome was the onset time of eyelid and globe akinesia. Also, the duration of the block was assessed in the three studied groups. Intraoperative and postoperative hemodynamic measures were assessed. Postoperative analgesia was hourly-assessed using Visual analogue scale (VAS) and rescue analgesia was provided at visual analogue score of > 3. Results The number of patients who had fast eyelid and globe akinesia was significantly higher with significantly lower total 15-min score in group F than the other groups. Intraoperative and postoperative hemodynamic measures were non-significantly different between studied groups. Duration of the block was significantly longer in groups F and M than group C with significantly longer duration in group F. The number of patients who required postoperative rescue analgesia was significantly lower with significantly lower number of requests in group F than the other groups. Conclusion Additives to local anesthetic mixture during peribulbar block provided satisfactory anesthetic outcome than local anesthetic mixture alone. Fentanyl was superior to midazolam in terms of significantly speed up onset, longer block duration with significantly longer postoperative analgesia and lesser consumption of rescue analgesia. Both additives provided adjusted hemodynamic measures comparable to the control group. Trial registration Pan African Clinical Trials Registry (PACTR201708002496243) registered 03/08/2017 retrospectively.

Background:Organophosphate (OP) poisoning is still a major health concern in both developed and developing countries. The standard treatment approaches of (OP) poisoning are not always available as well so they may show a limited success rate. Fresh frozen plasma (FFP) is one of Bio-scavengers that have been suggested as a useful therapy through elimination of free organophosphates. Therefore, this systematic review and meta-analysis was conducted to update the present evidence about the efficacy of FFP in management of acute OP-intoxicated patients. Method:A computer literature search of PubMed and Scopus was conducted to identify the relevant randomized controlled trials (RCTs). In addition, a manual search of reference lists of the retrieved articles was conducted. Relevant outcomes were pooled as mean difference (MD) risk ratio (RR) by RevMan version 5.3 for Windows. Results:Pooled data from 3 RCTs (169 patients) showed that adding FFP to conventional therapy to acutely OP intoxicated patients did not improve clinical outcomes regarding total atropine (MD = 35.05, 95% CI = [-41.14 to 111.24], P-value = 0.37) and pralidoxime dosages (MD = -0.41, 95% CI = [-2.34 to 1.51], P-value = 0.67), length of hospital stay (MD = -2.08, 95% CI = [-4.51 to 0.35], P-value = 0.09) and mortality (RR = 0.42, 95% CI = [0.14 to 1.27], P-value = 0.12). Conclusion: Fresh frozen plasma did not provide any additional benefit in acutely-OP intoxicated patients compared to the conventional therapy. The limited number and sizes of the included trials are the most probable cause of such effects.

It has been considered the existing methods of processing of video information resource in modern aircraft navigation systems and motion control. Also it is indicated that there is a contradiction between the need to reduce the intensity of information resource for strongly saturated fragments and to maintain the correspondence of recovered fragments to the original aerial photo. It has been described the components' characteristics of the transforming for the image's areas with varying structure complexity. The rationalization of the dividing strategy is based on the complexity of aerial photographs is substantiated. It is proposed to quantize the transformation's description of an aerial video information segment in relation to the base element's value vector to a certain threshold value. The reduction of combinatorial redundancy as a result of the application of top-level quantized levels array in a separable space is substantiated.

The organophosphate (OP) pesticide chlorpyrifos (CPF), used in agricultural settings, induces developmental and neurological impairments. Recent studies using in vitro cell culture models have reported CPF exposure to have a positive association with mitochondria-mediated oxidative stress response and dopaminergic cell death; however, the mechanism by which mitochondrial reactive oxygen species (ROS) contribute to dopaminergic cell death remains unclear. Therefore, we hypothesized that STAT1, a transcription factor, causes apoptotic dopaminergic cell death via mitochondria-mediated oxidative stress mechanisms. Here we show that exposure of dopaminergic neuronal cells such as N27 cells (immortalized murine mesencephalic dopaminergic cells) to CPF resulted in a dose-dependent increase in apoptotic cell death as measured by MTS assay and DNA fragmentation. Similar effects were observed in CPF-treated human dopaminergic neuronal cells (LUHMES cells), with an associated increase in mitochondrial dysfunction. Moreover, CPF (10 μM) induced time-dependent increase in STAT1 activation coincided with the collapse of mitochondrial transmembrane potential, increase in ROS generation, proteolytic cleavage of protein kinase C delta (PKCδ), inhibition of the mitochondrial basal oxygen consumption rate (OCR), with a concomitant reduction in ATP-linked OCR and reserve capacity, increase in Bax/Bcl-2 ratio and enhancement of autophagy. Additionally, by chromatin immunoprecipitation (ChIP), we demonstrated that STAT1 bound to a putative regulatory sequence in the NOX1 and Bax promoter regions in response to CPF in N27 cells. Interestingly, overexpression of non-phosphorylatable STAT1 mutants (STAT1Y701F and STAT1S727A) but not STAT1 WT construct attenuated the cleavage of PKCδ and ultimately cell death in CPF-treated cells. Furthermore, small interfering RNA knockdown demonstrated STAT1 to be a critical regulator of autophagy and mitochondria-mediated proapoptotic cell signaling events after CPF treatment in N27 cells. Finally, oral administration of CPF (5 mg/kg) in postnatal rats (PNDs 27–61) induced motor deficits, and nigrostriatal dopaminergic neurodegeneration with a concomitant induction of STAT1-dependent proapoptotic cell signaling events. Conversely, co-treatment with mitoapocynin (a mitochondrially-targeted antioxidant) and CPF rescued motor deficits, and restored dopaminergic neuronal survival via abrogation of STAT1-dependent proapoptotic cell signaling events. Taken together, our study identifies a novel mechanism by which STAT1 regulates mitochondria-mediated oxidative stress response, PKCδ activation and autophagy. In this context, the phosphorylation of Tyrosine 701 and Serine 727 in STAT1 was found to be essential for PKCδ cleavage. By attenuating mitochondrial-derived ROS, mitoapocynin may have therapeutic applications for reversing CPF-induced dopaminergic neurotoxicity and associated neurobehavioral deficits as well as neurodegenerative diseases.

Abstract Background Patients undergoing craniotomy operations are prone to various noxious stimuli, many strategies are commenced to provide state of analgesia, for better control of the stress response and to overcome its undesired effects on the haemodynamics and post-operative pain. Scalp nerves block are considered one of these strategies. This study was conceived to evaluate the effect of addition of hyaluronidase to the local anaesthetic mixture used in the scalp nerves block in patients undergoing elective craniotomy operations. Methods 64 patients undergoing elective craniotomy operations were enrolled in this prospective randomized, double-blind comparative study. Patients were randomly assigned to two groups. Group LA, patients subjected to scalp nerves block with 15 ml bupivacaine 0.5%, 15 ml lidocaine 2%, in 1:400000 epinephrine. Group H as Group LA with15 IU /ml Hyaluronidase. Results Patients in the H group showed lower VAS values for 8 h postoperative, compared to the LA group. The haemodynamic response showed lower values in the H group, compared to the LA group. Those effects were shown in the intraoperative period and for 6 h post-operative. No difference was detected regarding the incidence of complications nor the safety profile. Conclusion Our data supports the idea that addition of hyaluronidase to the local anesthetic mixture improves the success rates of the scalp nerves block and its efficacy especially during stressful intraoperative periods and in the early postoperative period. No evident undesirable effects in relation to the addition of hyaluronidase. Trial registration Clinical Trial registry on ClinicalTrials.gov, NCT 03411330, 25-1-2018.

Objectives: To evaluate the outcome of priming by varying-doses of metoclopramide on propofol injection pain in comparison to lidocaine as a standard control. Methods and materials: 320 patients were randomly allocated into 4 equal groups: Group C received 50 mg lidocaine and Groups M1-3 received metoclopramide 2.5, 5 and 10 mg, respectively. An elastic tourniquet was applied to the mid of left arm, the priming solution was injected over 10 s and 1-min later, tourniquet was removed and one fourth of the total calculated dose of Propofol was injected over 30 s and pain assessment was made, during initial and at end of injection of Propofol trial dose, using the 4-point verbal rating scale: no, mild, moderate or severe pain. Then, the reminder of the full calculated induction dose of Propofol was completed. Results: Lidocaine and metoclopramide mostly relieved pain of initiation of Propofol injection 174 patients (54.4%) had no pain 94 patients (29.4%) had mild pain and only 68 patients (21.25%) had moderate pain, while no patient had severe injection pain. At the end of injection of the total trial dose, 40% had no pain totally, 31.3% had mild pain, 19.3% had moderate pain and 9.4% had severe pain. Lidocaine provided significantly better analgesia compared to metoclopramide (2.5 mg), while the difference was non-significantly better compared to metoclopramide, 5 and 10 mg. Metoclopramide provided dose-dependent stepwise pain relieve peaking with 10 mg dose that showed significant superiority compared to 2.5 mg dose, but non-significantly compared to 5 mg dose. Moreover, the effect of 10 mg priming dose extended till completion of injection of the trial dose with significant difference Compared to the other two doses of metoclopramide. Conclusion: venous priming with metoclopramide 10 mg with mid-arm tourniquet applied for one minute is effective modality for alleviation of Propofol injection pain else Patients received Lidocaine showed significantly better analgesia compared to those received 2.5 mg metoclopramide. Keywords: Propofol injection pain, Metoclopramide, Lidocaine, Tourniquet, Venous priming

Abstract Vitamin D, a fat-soluble prohormone, has wide-ranging roles in the regulation of many physiological processes through their interactions with the vitamin D receptors (VDR). It plays a major role in bones and calcium metabolism. Vitamin D deficiency is not uncommon and it has been associated with many health-related issues, including skeletal and non-skeletal complications. The association of low vitamin D and cardiovascular diseases and risk factors has been explored in both animal and human studies. However, studies and trials on the effect of vitamin D supplementation on cardiovascular risk factors and hypertension are conflicting with inconsistent results. Therefore, large, well-powered randomized controlled trials are warranted. If successful, supplementation with easy and low-cost vitamin D can impact our health positively. Here, we summarized the evidence for the association of vitamin D, cardiovascular diseases and risk factors, including coronary artery diseases, stroke, and hypertension, and mortality, with special consideration to resistant hypertension.

Enterobacteriaceae are now the predominant pathogens isolated in patients with liver cell failure associated with bloodstream infections. We conducted a retrospective cohort study of patients who were admitted for the diagnosis of hepatorenal failure (HRF) between June 1999 and May 2008 to investigate the risk factors of Enterobacteriaceae bacteremia (EB). EB was defined as the isolation of an EB species from at least one blood culture within three months following diagnosis of HRF. Variables were collected from the medical records and analyzed in relation to EB. Twenty-four (32.5%) of the 73 patients developed EB. The origin of EB was abdominal in 21% of the patients, urinary in 12.5%, pulmonary in 16.5%, and primary in the remaining patients (50%). Two-thirds of EB occurred within 10 days following the development of HRF. The main pathogens were Escherichia coli (44%), Enterobacter species (20%) and Klebsiella pneumoniae (22%). Eighteen patients (75%) with EB died. Variables significantly associated with EB after multivariate analysis were a model for end-stage liver disease score >20 [odds ratio (OR): 2.84, P

Aim: The prevalence of celiac disease (CD) in patients with iron deficiency (ID) is estimated at 0–6% in European countries. The prevalence of celiac disease in patients with iron deficiency in the USA is unknown. Given the treatable nature of gluten hypersensitivity, estimating the prevalence of CD in patients with ID can help to determine the need to screen these patients for occult CD. Methods: Data were obtained from the NHANES database, a nationally representative health survey conducted from 2009 to 2010. We included 2,105 females aged 6 years or older. Iron deficiency was defined as serum ferritin level

Purpose: The objective of this study was to compare tumor characteristics, biomarkers, and surrogate subtypes of breast cancer between Sudanese and German women. Methods: Tumor characteristics and immunohistochemistry markers (estrogen receptor [ER], progesterone receptor [PR], and human epidermal growth factor receptor 2 [HER2]) were collected from the routine assessment of consecutive patients with invasive breast cancer diagnosed from 2010 to 2015 (Gezira University Pathology Laboratory, Gezira, Sudan) and from 1999 to 2013 (Breast Centre, Martin-Luther-University, Halle, Germany). Results: A total of 2,492 patients (German [n = 1,932] and Sudanese [n = 560]) were included. Age at diagnosis ranged from 20 to 94 years. Sudanese women were, on average, 10 years younger than German women, with a mean (± standard deviation) age of 48.8 (13.5) and 58.6 (12.4) years, respectively. The Sudanese women had a higher grade, larger tumor, and more lymph node positivity compared with German women. ER-, PR-, and HER2-negative proportions were 55%, 61.8%, and 71.3%, respectively, for Sudanese women versus 22.7%, 32.3%, and 82.5%, respectively, for German women. The triple-negative subtype was more prevalent in Sudanese women (34.5%) than in German women (14.2%). The strongest factor associated with ER-negative disease was grade III (odds ratio, 19.6; 95% CI 11.6 to 33.4; P < .001). Sudanese patients were at higher risk for ER-negative breast cancer, with an odds ratio of 2.01 (P = .001; adjusted for age, size, nodal status, histologic type, and grade). Stratified by grade, the influence of origin was observed in grade I and grade II tumors, but not in grade III tumors. Conclusion: Sudanese women had more aggressive tumor characteristics and unfavorable prognostic biomarkers. After adjustment, Sudanese origin was still associated with hormone receptor–negative disease, especially in grade I and II tumors. These findings suggest differences in tumor biology among these ethnic groups.

Hypercalcemia has many causes including primary hyperparathyroidism, malignancy, and other rare etiologies. In most of the cases, hypercalcemia is secondary to one etiology. In this case, we are reporting hypercalcemia with two causes. The initial workup showed primary hyperparathyroidism due to parathyroid adenoma. But because all features were not fully explained by primary hyperparathyroidism, further work-up revealed multiple myeloma. This case represents coexistence of two different diseases, which was rarely reported in the literature previously. Usually, the co-diagnosis was made subsequently after failure to correct hypercalcemia. In our case, both diagnoses were established at the same time of the patient’s presentation as of high suspicion. Establishing the diagnosis early will aid in the initiation of treatment in a timely fashion.

Beetroot is a good source of minerals, fibers, and bioactive components. The present research work was conducted to evaluate the nutritional quality of beetroots (juice, peels, leaves and pomace) enhancing the extracted bioactive components, and developing a functional probiotic beverage. Chemical composition and minerals content of beetroot parts were estimated. The bioactive components were extracted by instant extraction method (IEM) and overnight extraction method (at −20 °C) (OEM) to determine total phenolics, flavonoids, and DPPH inhibition ratio. The extracted beetroot juice was mixed with milk for valorization of the beverage nutritional value and fermented with LA-5 and ABT-5 cultures to create a novel functional beverage. Chemical composition, minerals content, and bioactive components of beverages were estimated. The leaves exhibited the highest calcium content (1200 mg/100 g). Juice showed the highest amount of all minerals except for calcium and magnesium. Overnight extraction method (OEM) increased the antioxidant activity in peels and stems. Natural juice exhibited the highest activity compared to extracts. Fermentation of beet-milk beverage with LA-5 and ABT-5 cultures enhanced the beverage taste, flavor, and antioxidant capacity. Beetroot wastes and juice comprise a valuable nutritional source. Fermentation improved the nutritional value of beetroot and the acceptability of the product.

Objectives: We assessed whether at admission plasma circulating cell free mitochondrial DNA (ccf-mtDNA) is related to injury severity and can predict morbidity and mortality in acute trauma patients. Patients and methods: Patients were evaluated at Emergency Department (ED) using Injury Severity Scale (ISS), but only patients required ICU admission were studied (Group B). At ED arrival, blood samples were obtained for quantitative real-time PCR estimation of plasma level of ccf-mtDNA. Study outcome was the correlation between morbidity and mortality and at admission plasma ccf-mtDNA level and its predictability for morbidity and mortality. Ten healthy volunteers gave blood samples as control group (Group B). Results: Twenty-seven patients passed smooth ICU stay and were discharged alive (Group B1), while 34 patients developed additional morbidities (Group B2) and 11 patients (18%) of Group A2 died. Mean estimated plasma ccf-mtDNA levels were significantly higher in Group B than in Group A, but patients of Group B1 had significantly lower ccf-mtDNA levels than patients of Group B2. Patients developed adult respiratory distress syndrome (ARDS) had significantly higher ccf-mtDNA levels than patients developed sepsis or acute myocardial infarction (AMI) with significantly higher levels in patients developed sepsis. Estimated plasma ccf-mtDNA levels at time of admission showed positive significant correlation with morbidity rate. Odds ratio (OR) for relative risk for development of additional morbidities in patients who had a high plasma ccf-mtDNA level was 26.35. At admission plasma ccf-mtDNA levels in survivors were significantly lower than in non-survivors, and OR was 4.0806. High plasma ccf-mtDNA showed high sensitivity as predictor for ICU mortality. Conclusion: High at ED admission plasma ccf-mtDNA levels could predict development of additional morbidities during ICU stay of acute trauma patients and showed high sensitivity for prediction of their survival. Very high plasma ccf-mtDNA levels could predict patients liable to develop ARDS.

Objectives: Evaluation of fluid responsiveness of septic shock patients admitted to surgical ICU and the predictability of non-invasive monitoring and estimated lactate/pyruvate (L/P) ratio for survival of these patients. Patients and methods: The study included 58 septic shocked patients admitted and managed at surgical ICU. After non-invasive determination of baseline hemodynamic data and calculation of shock index (SI-0) and Pleth variability index (PVI-0), all patients received intravenous colloid infusion followed 15-min later by non-invasive re-evaluation for SI-15 and PVI-15. Blood samples were obtained for estimation of blood lactate and pyruvate levels at admission (BLL-0 and BPL-0) and 12-h after fluid resuscitation (BLL-12 and BPL-12) and L/P ratio was calculated. All patients were managed according to the Surviving Sepsis Campaign guidelines and followed up for ICU mortality rate (MR). Results: ICU stay MR was 20.7%. Survival showed negative significant correlation with PVI, L/P ratio and BLL, while it showed positive significant correlation with BPL. Receiver Operating Characteristic (ROC) curve analysis defined baseline and persistently low PVI, high BLL and L/P ratio as significant sensitive predictors for MR, while elevated BPL-12 as significant specific predictor for survival. Regression analysis defined persistently elevated L/P ratio as the highly significant specific predictor, while persistently disturbed SI and PVI could predict mortality as screening tests. Odds ratio for mortality at BLL-0 of >2 mmol/L was 0.0321 (95% CI: 0.0037–0.2755), while it was 4.1111 (95% CI: 1.0702–15.792) at BLL-0 >4 mmol/L. Conclusion: After fluid resuscitation and hemodynamic stability, persistently elevated BLL could predict mortality, while elevated BPL could predict survival of septic shock patients. Continuous non-invasive evaluation of fluid responsiveness judged by PVI and SI could provide sensitive screening for survival outcome of shocked patients. Wider scale comparative studies are mandatory for establishment of discriminative PVI and BLL cutoff points for prediction of survival of shocked patients.

BACKGROUND:Deliberate self-poisoning (DSP) using organophosphorus (OP) insecticides are a common clinical problem in Asia. OPs inhibit acetylcholine esterase (AChE), leading to over-activity of muscarinic and nicotinic cholinergic circuits. Intermediate syndrome (IMS) is mediated via prolonged nicotinic receptor stimulation at the neuromuscular junction and its onset is between 24-96 hours post ingestion. The aims of the present study were 1) to investigate whether neuromuscular junction dysfunction within the first 24 hours following exposure, quantified by jitter in single fibre electromyography (SfEMG), can predict IMS, and 2) to compare the changes in SfEMG jitter over the course of the illness among patients who developed IMS (IMS+) and those who did not (IMS-). METHODS AND FINDINGS:We conducted a prospective cohort study in a tertiary care hospital in Sri Lanka on 120 patients admitted between September 2014 and August 2016 following DSP by OP insecticides viz., profenofos 53, phenthoate 17, diazinon 13, chlorpyrifos 5, others 12, unknown 20. SfEMG was performed every second day during hospitalization. Exposure was confirmed based on the history and red blood cell AChE assays. IMS was diagnosed in patients who demonstrated at least three out of four of the standard IMS criteria: proximal muscle weakness, bulbar muscle weakness, neck muscle weakness, respiratory paralysis between 24-96 hours post ingestion. Respiratory failure requiring intubation occurred in 73 out of 120 patients; 64 of these were clinically diagnosed with IMS. Of the 120 patients, 96 had repeated SfEMG testing, 67 of them being tested within the first 24 hours. Prolonged jitter (>33.4μs) within the first 24 hours was associated with greatly increased risk of IMS (odds ratio = 8.9, 95% confidence intervals = 2.4-29.6, p = 0.0003; sensitivity 86%, specificity 58%). The differences in jitter between IMS+ and IMS- patients remained significant for 72 hours and increased jitter was observed in some patients for up to 216 hours. For intubated patients, the median time for jitter to normalize and median time to extubate were similar, and the two variables had a moderate positive correlation (r = 0.49, P = 0.001). CONCLUSIONS:Prolonged jitter recorded with SfEMG

Objectives: To estimate plasma monoethylglycinexylidide (MEGX) level at 15 and 30 min after intravenous injection of lidocaine as a measure for detoxification and excretory function of the liver in cirrhotic patients in comparison with non-cirrhotic patients assigned for laparoscopic cholecystectomy (LC). Patients and methods: The study included 50 cirrhotic and 10 non-cirrhotic patients assigned for LC. Only Child-Pugh (CP) class A or B patients with adjusted liver functions were included in the study. Both patients and controls received anesthesia using a similar protocol. Intravenous lidocaine (1 mg/kg) was injected over 1 min, and blood samples were obtained immediately before lidocaine injection (S0) to assure absence of MEGX in plasma and 15 min (S15) and 30 min (S30) after lidocaine administration. MEGX values > 90 ng/ml are considered normal. The extent of MEGX extraction was calculated as plasma MEGX level at S30 minus S15. Results: Mean operative and anesthesia times were 59.3 ± 10.4 and 73.9 ± 12.2 min, respectively. Mean sevoflurane 18.1 ± 2.4 ml/h. Operative and anesthetic data showed non-significant difference between patients categorized according to CP class and in comparison with controls. Estimated plasma MEGX levels at 15-min and 30-min after lidocaine injection were significantly higher in controls compared to patients and in patients of CP class A compared to those of class B. The extent of extraction was significantly lower in patients of CP class B compared both to controls and patients of class A with non-significantly lower extraction level in patients of class A compared to controls. Conclusion: Laparoscopic cholecystectomy is safe and feasible in cirrhotic patients and MEGX test as a measure of detoxification and excretory function of the liver is a reliable test that showed a relationship to the extent of hepatic derangement.

Few studies have used crustal displacements sensed by the Global Positioning System (GPS) to assess the terrestrial water storage (TWS), which causes loadings. Furthermore, no study has investigated the feasibility of using GPS to image TWS over South America (SA), which contains the world’s driest (Atacama Desert) and wettest (Amazon Basin) regions. This work presents a resolution analysis of an inversion of GPS data over SA. Firstly, synthetic experiments were used to verify the spatial resolutions of GPS-imaged TWS and examine the resolving accuracies of the inversion based on checkerboard tests and closed-loop simulations using “TWS„ from the Noah-driven Global Land Data Assimilation System (GLDAS-Noah). Secondly, observed radial displacements were used to image daily TWS. The inverted results of TWS at a resolution of 300 km present negligible errors, as shown by synthetic experiments involving 397 GPS stations across SA. However, as a result of missing daily observations, the actual daily number of available stations varied from 60–353, and only 6% of the daily GPS-imaged TWS agree with GLDAS-Noah TWS, which indicates a root-mean-squared error (RMSE) of less than 100 kg/m 2 . Nevertheless, the inversion shows agreement that is better than 0.50 and 61.58 kg/m 2 in terms of the correlation coefficient (Pearson) and RMSE, respectively, albeit at each GPS site.

In the original publication of this article [1], the reference number [42] under the section ‘vitamin D and Cardiovascular diseases’ (page no.2) should be [37].