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Nickel (Ni) is considered a toxic heavy metal that causes serious diseases in humans and animals. Therefore, this study was conducted on common carp, which is considered an essential food item for humans. This study was designed to investigate the effect of nickel on the hepatic and antioxidant enzymes of Cyprinus carpio after 3 and 6 weeks of exposure to water contaminated with Ni. C. carpio fingerlings were purchased from a neighboring fish hatchery. The morphometric characteristics of the experimental fish were documented. All fish were stocked, regardless of gender. The fish were exposed to different concentrations (20, 40, 60, 80, and 100 mg/L) to obtain the LC50 for Ni during 96 hours, and the median lethal concentration of Ni was 80 mg/L through 96 hours. The fish were exposed to two safe concentrations, 1 ppm and 5 ppm. The results after 3 and 6 weeks were as follows: When compared to the control groups, all treated groups had significantly higher levels of liver function parameters (ALT and AST). Malondialdehyde (MDA) and catalase activity measurement (CAT) enzyme levels were considerably higher in all treated groups after 3 and 6 weeks as compared to control groups. These changes are trustworthy indications of the cellular and humoral immune responses in C. carpio.

Continuous Renal Replacement Therapy (CRRT) serves as an intervention strategy for the management of acute kidney injury (AKI) in critically ill patients. However, owing to its complex nature and the potential for complications, the implementation of CRRT demands continuous monitoring to prevent patient safety risks. This study aims to identify and validate prevalent risks linked to CRRT within a real-world clinical setting, intending to propose preventive measures grounded in expert insights. To systematically categorize and visually depict the risks, their consequences, preventive measures, and recovery controls, our study employed the Bowtie method in conjunction with the Systems Engineering Initiative for Patient Safety (SEIPS) model. In addition to considering patient-related factors that exhibit variability among critically ill individuals, our key findings showed that the most influential risks impacting the effective delivery of CRRT are incidents of clotted filters, bleeding risks arising from the necessity of anticoagulation for filter efficacy, vascular catheter-related bloodstream infections, variations in proficiency levels among healthcare professionals regarding CRRT modalities, especially in operating the CRRT machines, high nursing workload, frequent nursing turnover, occurrences of hypophosphatemia, variability in CRRT prescribing patterns, and issues related to communication among stakeholders. This research sheds light on the primary risks associated with CRRT and provides practical and viable strategies for effective management. Furthermore, the Bowtie diagram developed as part of this study serves as a valuable tool for visually representing the healthcare system and facilitating the identification of system-related risks within healthcare settings.

Abstract Introduction Magnesium sulfate is the most utilized anticonvulsant for treating patients with eclampsia and pre-eclampsia. The purpose of this study is to determine whether the 12-h regimen of magnesium sulfate outweighs the 24-h regimen in both efficacy and safety in the management of patients with mild or severe pre-eclampsia and eclampsia. Methods We searched six electronic databases: PubMed, Scopus, Web of Science, Cochrane Library, Ovid, and Google Scholar. This search was conducted to yield any studies that were published until 15 January 2023. We did the statistical analysis plan by Review Manager Software version 5.4. Results We included 13 randomized control trials with 2813 patients in this systematic review. Our meta-analysis revealed that there were no statistically significant differences between the 12-h regimen of the magnesium sulfate group and the 24-h regimen of the magnesium sulfate group in our outcome of interest: occurrence of seizure (RD: -0.00, 95% CI [-0.01, 0.00], P = 0.56), diminished deep tendon reflexes (RD: -0.00, 95% CI [-0.01, 0.01], P = 0.80), respiratory depression (RD: -0.00, 95% CI [-0.02, 0.01], P = 0.57), and pulmonary edema (RD: -0.00, 95% CI [-0.01, 0.01], P = 0.85). Conclusion Our study showed no statistically significant difference in effectiveness and toxicity risk between the 12-h and 24-h regimens.

Abstract Background Female breast cancer stands as the prime type of cancer in the Kingdom of Saudi Arabia (KSA), with a high incidence and mortality rates. This study assessed the burden of female breast cancer in KSA by analyzing and forecasting its incidence, mortality, and disability-adjusted life years (DALYs). Methods We retrieved data from the Global Burden of Disease (GBD) about female breast cancer from 1990 to 2021. Time-series analysis used the autoregressive integrated moving average (ARIMA) model to forecast female breast cancer statistics from 2022 to 2026. Results From 1990 to 2021, KSA reported 77,513 cases of female breast cancer. The age groups with the highest number of cases are 45–49 years, followed by 40–44 years, 50–54 years, and 35–39 years. The analysis also showed fewer cases in the younger age groups, with the lowest number in the less than 20-year-old age group. From 1990 to 2021, KSA reported 19,440 deaths due to breast cancer, increasing from 201 cases in 1990 to 1,190 cases in 2021. The age-standardized incidence rate/100,000 of breast cancer increased from 15.4 (95% confidence interval (CI) 11.2–21.0) in 1990 to 46.0 (95%CI 34.5–61.5) in 2021. The forecasted incidence rate of female breast cancer will be 46.5 (95%CI 45.8–46.5) in 2022 and 49.6 (95%CI 46.8–52.3) in 2026. The age-standardized death rate per 100,000 Saudi women with breast cancer increased from 6.73 (95%CI 6.73–9.03) in 1990 to 9.77 (95%CI 7.63–13.00) in 2021. The forecasted female breast cancer death rate will slightly decrease to 9.67 (95%CI 9.49–9.84) in 2022 and to 9.26 (95%CI 8.37–10.15) in 2026. DALYs increased from 229.2 (95%CI 165.7–313.6) in 1990 to 346.1 (95%CI 253.9–467.2) in 2021. The forecasted DALYs of female breast cancer will slightly decrease to 343.3 (95%CI 337.2–349.5) in 2022 reaching 332.1 (95%CI 301.2–363.1) in 2026. Conclusions Female breast cancer is still a significant public health burden that challenges the health system in KSA, current policies and interventions should be fashioned to alleviate the disease morbidity and mortality and mitigate its future burden.

Abstract Background Extracorporeal membrane oxygenation (ECMO) has been presented as a potential therapeutic option for patients with cardiogenic shock complicating myocardial infarction (CS-MI). We aimed to investigate the efficacy and safety of ECMO in CS-MI. Methods A systematic review and meta-analysis synthesizing evidence from randomized controlled trials obtained from PubMed, Embase, Cochrane, Scopus, and Web of Science until September 2023. We used the random-effects model to report dichotomous outcomes using risk ratio and continuous outcomes using mean difference with a 95% confidence interval. Finally, we implemented a trial sequential analysis to evaluate the reliability of our results. Results We included four trials with 611 patients. No significant difference was observed between ECMO and standard care groups in 30-day mortality with pooled RR of 0.96 (95% CI: 0.81–1.13, p = 0.60), acute kidney injury (RR: 0.65, 95% CI: 0.41–1.03, p = 0.07), stroke (RR: 1.16, 95% CI: 0.38–3.57, p = 0.80), sepsis (RR: 1.06, 95% CI: 0.77–1.47, p = 0.71), pneumonia (RR: 0.99, 95% CI: 0.58–1.68, p = 0.96), and 30-day reinfarction (RR: 0.95, 95% CI: 0.25–3.60, p = 0.94). However, the ECMO group had higher bleeding events (RR: 2.07, 95% CI: 1.44–2.97, p

The scientific methodology for forensic examination of handwriting is based on studying the individual handwriting features and characteristics that distinguish its writer from others. The general qualities and the more detailed ones, some of which are "static" and refer to pictorical elements, while others refer to the pen's "dynamic" movement are investigated. Forensic handwriting experts during their daily activities are asked to analyse various features, many of which are suggested by the most prominent authors (connections, dimensions, proportions, shape, inclination, line quality, etc.), some of which are measurable, while others can only be inferred. However, the recent emergence of digitally captured signature (DCS) technology in the forensic field, has enabled the expert to analyse and evaluate new aspects, such as the length of the line. In the present study, an attempt has been made to study the line length and its possible uses in forensics handwriting examination processes. The authors, with different backgrounds and with different writing styles (Latin alphabet - Arabic alphabet), have tried to go further than the so far known study of handwriting for forensic purposes, studying and comparing the genuine lengths of the signature line and those that are forged (simulated).

The aim of the currnet study to examine the effect of subclinical hypothyroidism (SCH) in diabetic patients on coagulation parameters. This retrospective case–control study involves 130 patients diagnosed with type 2 diabetes mellitus (T2DM), divided into 65 T2DM with newly diagnosed SCH and 65 euthyroid (EUT) T2DM patients without SCH. Fibrinogen (FIB) was significantly higher in SCH (508.2 ± 63.0 mg/dL) than EUT (428.1 ± 44.8 mg/dL). In the SCH patients, FIB correlated with several parameters, such as age (β = 0.396), body mass index (β = 0.578), glycated hemoglobin (β = 0.281), and activated partial thromboplastin time (β = 0.276). In conclusion SCH in DM patients appears to increase the magnitude of coagulopathy.

Abstract Background The humanized monoclonal antibody galcanezumab is an anti-calcitonin-gene-related-peptide (CGRP) and frequently used for migraine prevention. However, the literature revealed limited data with conflicting results. This study aims to assess the safety and efficacy of galcanezumab in treating patients with episodic or chronic migraine. Methods We searched for randomized controlled trials till September 2022 from six databases (Cochrane library, Embase, PubMed, Web of Science, Scopus, and Clinicaltrials.gov registry). Our primary outcomes were the change in the number of monthly migraine headache days (MHDs) and adverse events. We extracted the data and analyzed it by RevMan (5.4) software. Results Eight studies with 4964 patients were included. Galcanezumab (≥ 120 mg) significantly reduced the MHDs for six months in migraine patients compared to placebo. The monthly risk ratio (RR) ranged from − 2.33 to − 1.62 for episodic migraine and − 2.86 to − 2.44 for chronic migraine. The response rate of ≥ 50%, ≥ 75% and 100% were higher with galcanezumab groups. The rate ranged from 1.72 to 4.19 for episodic migraine and 1.84 to 2.47 for chronic migraine. It is generally safe except for injection site safety outcomes (erythema, reaction, pruritis, and swelling), the results were significantly higher with galcanezumab groups. It appears dose independent except for injection site reaction, which showed higher with galcanezumab 120 mg only. Furthermore, any adverse events, serious adverse events (SAE) and that led to discontinuation were higher with galcanezumab 240 mg. Conclusion Galcanezumab is effective in patients with episodic or chronic migraine after one to six months use. It reduced MHDs and had an effective response rate. Moreover, it is generally safe except for injection site adverse events, and SAE, especially with galcanezumab 240mg.

BackgroundChimeric antigen receptor (CAR) T-cell therapy has attracted considerable attention since its recent endorsement by the Food and Drug Administration, as it has emerged as a promising immunotherapeutic modality within the landscape of oncology. This study explores the prognostic utility of [18F]Fluorodeoxyglucose positron emission tomography ([18F]FDG PET) in lymphoma patients undergoing CAR T-cell therapy. Through meta-analysis, pooled hazard ratio (HR) values were calculated for specific PET metrics in this context.MethodsPubMed, Scopus, and Ovid databases were explored to search for relevant topics. Dataset retrieval from inception until March 12, 2024, was carried out. The primary endpoints were impact of specific PET metrics on overall survival (OS) and progression-free survival (PFS) before and after treatment. Data from the studies were extracted for a meta-analysis using Stata 17.0.ResultsOut of 27 studies identified for systematic review, 15 met the criteria for meta-analysis. Baseline OS analysis showed that total metabolic tumor volume (TMTV) had the highest HR of 2.66 (95% CI: 1.52-4.66), followed by Total-body total lesion glycolysis (TTLG) at 2.45 (95% CI: 0.98-6.08), and maximum standardized uptake values (SUVmax) at 1.30 (95% CI: 0.77-2.19). TMTV and TTLG were statistically significant (p < 0.0001), whereas SUVmax was not (p = 0.33). For PFS, TMTV again showed the highest HR at 2.65 (95% CI: 1.63-4.30), with TTLG at 2.35 (95% CI: 1.40-3.93), and SUVmax at 1.48 (95% CI: 1.08-2.04), all statistically significant (p ≤ 0.01). The ΔSUVmax was a significant predictor for PFS with an HR of 2.05 (95% CI: 1.13-3.69, p = 0.015).Conclusion[18F]FDG PET parameters are valuable prognostic tools for predicting outcome of lymphoma patients undergoing CAR T-cell therapy.

BackgroundSoft drink consumption is continuing to grow worldwide, posing an increasing threat to people’s health and general wellbeing. Consequently, we must understand the factors driving soft drink consumption to support improvements to nutrition. This paper adopts a qualitative research approach to explore individuals’ perceptions of the factors linked to daily soft drink consumption among university students in Saudi Arabia.Materials and methodsThis research employed purposive sampling to recruit a total of 19 students attending university in Al Madinah Province, Saudi Arabia, all of whom reported that they had previously consumed soft drinks. Over 3 months, data was gathered through a mixture of online and in-person semi-structured interviews. Once completed, the interviews were then transcribed and analyzed using inductive thematic analysis to identify the themes that emerged from the data.ResultsThis study reveals five core themes: taste, habit, price, environment and social context, and health concerns. Regarding health concerns, this study finds that the public’s increasing concerns about health can reduce people’s consumption of soft drinks. Significantly, this research reveals that the rise in health concerns among the public is being driven by the growing conversation about healthy food and the negative impact of consuming sugary soft drinks occurring in wider society.ConclusionTo conclude, this research underlines the value of adopting a holistic approach to promoting healthier drink choices (and thus reducing soft drink consumption). Interventions that focus on factors associated with soft drink consumption, such as habits, price, environment, social settings, health concerns, and taste, will be better able to decrease soft drink consumption and improve people’s nutritional intake.

Introduction: In diabetes mellitus (DM) patients, obtaining a good night’s sleep is crucial for maintaining body caloric intake, controlling insulin levels, and reducing the likelihood of engaging in unhealthy behavior. Patients with poor sleep quality may experience impaired glycemia, playing a significant role in the development of chronic complications. This study aims to explore the effects of DM complications on sleep quality among Saudi Arabian patients. Patient and Methods: This is a cross-sectional study conducted among patients with diabetes. A self-administered, validated questionnaire translated into Arabic was distributed among diabetic patients using an online survey. The questionnaire includes sociodemographic characteristics (i.e. age, gender, marital status, etc.), the medical history of the patients, and a questionnaire about sleep quality. Results: Out of 4171 patients involved, 52.7% were females and 27.7% were aged between 40 and 60 years old. The prevalence of patients with perceived poor sleep quality was 24.1%. Significant predictors of poor sleep quality were the gender female, having social stressors, comorbid sleep disorders, associated comorbidities, increasing HbA1c levels, being overweight/obese, and diabetes complications. Furthermore, sleep disturbance, taking sleep medications, daytime sleepiness, and having bad dreams during sleep were also identified as prognostic factors for poor sleep quality. Conclusion: The subjective poor sleep quality of patients with diabetes was 24.1%. Poor sleep quality was significantly demonstrated by females who were having social stressors, comorbid sleep disorders, comorbidities, uncontrolled HbA1c levels, elevated BMI levels, and complications of diabetes. However, regular physical activity and adequate sleep were estimated to be the protective factors against poor sleep quality. Further research is needed to establish the effect of sleep quality among patients with DM.

BackgroundThe incidence of thyroid cancer is on the rise worldwide, with childhood exposure to radiation being the sole acknowledged catalyst for its emergence. Nonetheless, numerous other factors that may pose risks are awaiting thorough examination and validation. This retrospective study aims to explore the malignancies linked to thyroid cancer and contrast the survival rates of those afflicted with a solitary tumor versus those with multiple primary neoplasms (MPN).MethodsThis retrospective study examined data from King Hussein Cancer Center (KHCC), Jordan. Among 563 patients diagnosed with thyroid cancer, 30 patients had thyroid malignancy as part of MPN. For a 1:3 propensity score-matched analysis, 90 patients with only a primary thyroid malignancy were also enrolled.ResultsHematologic and breast malignancies were among the most frequent observed cancers alongside thyroid neoplasm. Patients who had MPN were diagnosed at older age, had higher body mass index and presented with higher thyroglobulin antibody levels (p < 0.05 for each). Additionally, MPN patient displayed a stronger family history for cancers (p= 0.002). A median follow-up duration of 135 months unveiled that MPN patients faced a worse 5-year survival compared to their counterparts with a singular neoplasm (87% vs 100% respectively; p < 0.01). However, no distinction emerged in the 5-year event-free survival between these two groups.ConclusionMPN correlates with a significantly altered survival outcome of thyroid cancer patients. The diagnosis of thyroid carcinoma at an older age, accompanied by elevated initial thyroglobulin antibody levels and a notable familial predisposition, may raise concerns about the potential occurrence of synchronous or metachronous tumors.

This paper develops a real-time (RT) transmission and distribution (T&D) co-simulation platform for testing distributed energy resources management system (DERMS) algorithms. The platform consists of a transmission system modeled within a real-time transient-stability type environment interfaced to an active distribution network modeled within a fundamental frequency phasor-domain platform. The data exchange and time synchronization between the T&D models has been established via MQTT communication protocol, enabling the platform to communicate with a large number of DER models in real-time. The developed platform is generic in the sense that it can integrate an arbitrarily sized transient stability-type model of a transmission system with an arbitrarily sized fundamental frequency phasor-domain model of a distribution system. The platform does not impose an inherent limit on the size of the T&D models, and the size is limited by the computational capability of the simulation computer. This feature enables utilizing the platform for simulation studies of large-scale T&D systems. Furthermore, the developed platform enables both off-line and real-time simulations, extending its application from off-line planning-type studies to real-time operation-type and hardware-in-the-loop (HIL) studies. The paper demonstrates the application of the developed platform in a large-scale case study utilizing behind-the-meter (BTM) DERs to provide grid services when controlled by a DERMS. By including the propagation of dynamics between the simulation domains, realistic DER models, and typical communication protocols that are used in the field, the proposed platform enables the testing of DERMS algorithms in a close to real environment, replicating a wide range of power system phenomena that highlight the impact of a DERMS in an actual power system.

With the increase in the number of Internet of Things (IoT) applications, the reliance on robust networking, reliable communications, and efficient and secure data storage is increasing day by day. Many of these applications such as cellular communications, transportation networks and Internet of Medical Things generate huge volumes of data that need to be stored and analyzed to generate insights and make decisions related to applications. Security of data storage is a paramount concern, particularly in the current cyber security threat landscape. It is important to design novel techniques and algorithms to protect the data against these upcoming attacks. This paper provides a brief overview of security challenges faced by the data storage mechanisms. In comparison to the existing review papers in this area, the work in this paper identifies three major security techniques for data storage and conducts a comprehensive review of the recent advancements related to these techniques. These techniques include Blockchain algorithms, encryption mechanisms, and deduplication algorithms for data storage. Finally, the work highlights future opportunities and challenges related to secure data storage in future networks.

Background Periostitis ossificans (PO) are rare, benign ossifying surface lesions characterized by the centripetal ossification with osseous and soft-tissue edema. Their clinicoradiological appearances can easily mimic those of more sinister or infective surface lesion.

Abstract Background Middle East respiratory syndrome coronavirus (MERS-CoV) was identified in humans in 2012. Since then, 2605 cases and 937 associated deaths have been reported globally. Camels are the natural host for MERS-CoV and camel to human transmission has been documented. The relationship between MERS-CoV shedding and presence of neutralizing antibodies in camels is critical to inform surveillance and control, including future deployment of camel vaccines. However, it remains poorly understood. The longitudinal study conducted in a closed camel herd in Egypt between December 2019 and March 2020 helped to characterize the kinetics of MERS-CoV neutralizing antibodies and its relation with viral shedding. Results During the 100-day longitudinal study, 27 out of 54 camels (50%) consistently tested negative for presence of antibodies against MERS-CoV, 19 (35.2%) tested positive and 8 (14.8%) had both, positive and negative test results. Fourteen events that could be interpreted as serological indication of probable infection (two seroconversions and twelve instances of positive camels more than doubling their optical density ratio (OD ratio) in consecutive samples) were identified. Observed times between the identified events provided strong evidence (p = 0.002) against the null hypothesis that they occurred with constant rate during the study, as opposed to clustering at certain points in time. A generalized additive model showed that optical density ratio (OD ratio) is positively associated with being an adult and varies across individual camels and days, peaking at around days 20 and 90 of the study. Despite serological indication of probable virus circulation and intense repeated sampling, none of the tested nasal swab samples were positive for MERS-CoV RNA, suggesting that, if the identified serological responses are the result of virus circulation, the virus may be present in nasal tissue of infected camels during a very narrow time window. Conclusions Longitudinal testing of a closed camel herd with past history of MERS-CoV infection is compatible with the virus continuing to circulate in the herd despite lack of contact with other camels. It is likely that episodes of MERS-CoV infection in camels can take place with minimal presence of the virus in their nasal tissues, which has important implications for future surveillance and control of MERS-CoV in camel herds and prevention of its zoonotic transmission.

Background and Objectives: The frequency of multidrug-resistant Klebsiella pneumoniae (MDRKP) has dramatically increased worldwide in recent decades, posing an urgent threat to public health. The aim of this study was to assess the extent of K. pneumoniae in the Aseer region and explore the corresponding antimicrobial resistance profile over the last ten years. Materials and Methods: A record-based retrospective study was conducted in a tertiary hospital during the period of 2013 to 2022. The study targeted laboratory samples taken from patients admitted to the hospital and sent for K. pneumoniae culturing. We included only samples taken from the patient and confirmed by the lab. Data were extracted using a pre-structured data extraction sheet to avoid data-collection bias and confirm the inter-rater precision. Statistical Package for Social Sciences (SPSS) version 26 was employed for statistical analysis. All relationships were tested using Pearson X2 test for categorical data or chi-square for linear trend for resistance rate over years. Results: We obtained 3921 samples of isolated K. pneumoniae out of 28,420 bacterial samples. The isolation rate began at 11.3% in 2013, decreased to 6.1% in 2016, and then increased to a peak of 16.3% in 2021, before slightly decreasing to 12.8% in 2022. In total, 23.7% of K. pneumoniae samples were identified in urine samples, 19% in sputum samples, 14% in wound samples, and 11.7% in blood samples. The overall antibiotic resistance rate of K. pneumoniae from 2013 to 2022 showed a significant increase, particularly during 2020 and 2021, before decreasing again in 2022. The resistance rate decreased from 22.2% in 2013 to 18.6% in 2016 and increased to 54.6% and 56.4% during 2020 and 2021, respectively (p = 0.039). Conclusions: We observed a significant shift in K. pneumoniae resistance for some antibiotics during the study period, highlighting the urgent need for enhanced antimicrobial stewardship and infection-control measures.

Introduction The waiting list for elective surgery in England recently reached over 7.8 million people and waiting time targets have been missed since 2010. The high-volume low complexity (HVLC) surgical hubs programme aims to tackle the backlog of patients awaiting elective surgery treatment in England. This study will evaluate the impact of HVLC surgical hubs on productivity, patient care and the workforce.Methods and analysis This 4-year project consists of six interlinked work packages (WPs) and is informed by the Consolidated Framework for Implementation Research. WP1: Mapping current and future HVLC provision in England through document analysis, quantitative data sets (eg, Hospital Episodes Statistics) and interviews with national service leaders. WP2: Exploring the effects of HVLC hubs on key performance outcomes, primarily the volume of low-complexity patients treated, using quasi-experimental methods. WP3: Exploring the impact and implementation of HVLC hubs on patients, health professionals and the local NHS through approximately nine longitudinal, multimethod qualitative case studies. WP4: Assessing the productivity of HVLC surgical hubs using the Centre for Health Economics NHS productivity measure and Lord Carter’s operational productivity measure. WP5: Conducting a mixed-methods appraisal will assess the influence of HVLC surgical hubs on the workforce using: qualitative data (WP3) and quantitative data (eg, National Health Service (NHS) England’s workforce statistics and intelligence from WP2). WP6: Analysing the costs and consequences of HVLC surgical hubs will assess their achievements in relation to their resource use to establish value for money. A patient and public involvement group will contribute to the study design and materials.Ethics and dissemination The study has been approved by the East Midlands—Nottingham Research Ethics Committee 23/EM/0231. Participants will provide informed consent for qualitative study components. Dissemination plans include multiple academic and non-academic outputs (eg, Peer-reviewed journals, conferences, social media) and a continuous, feedback-loop of findings to key stakeholders (eg, NHS England) to influence policy development.Trial registration Research registry: Researchregistry9364 (https://www.researchregistry.com/browse-the-registry%23home/registrationdetails/64cb6c795cbef8002a46f115/).

Objective: This study utilized the cone-beam computed tomography (CBCT) to investigate the prevalence of lower and upper jaw fenestration and dehiscence in individuals with normal patterns, with a particular focus on central incisors to first molars on the two sides. Materials and Methods: An analysis was conducted on a cohort of 415 patients treated from January 2022 to December 2022 in the periodontal departments of Baghdad, Sulemania, Basra, and Najaf. There was a total of 174 males and 241 females that had Class I characteristics with normal anterior region patterns. The study focused on the occurrence of fenestration and dehiscence in the dentated area of both the right and left sides. These occurrences were subjected to statistical analysis. Results: Dehiscence has been seen in 4.89% of the assessed mandibular teeth, whereas fenestration was observed in 0.73% of the same teeth. Dehiscences were seen in 9.78% of the examined cases in the upper jaw, while fenestrations were discovered in 5.13% of the cases. These findings indicate a significant difference in the frequency of these conditions between the upper and lower jaws. Conclusion: The occurrence of dehiscence in both jaws was found to be greater than the occurrence of fenestration. The observed patterns suggested that these findings are more possibly to be attributed to physiological instead of pathological factors.

Introduction Considerable attention is focused on preoperative templating of radiological images in patients undergoing total knee arthroplasty to obtain optimal alignment and outcome. Several radiological measurements have been described.

Abstract Background The purpose of this study was to assess the usefulness of fluorodeoxyglucose positron emission tomography (18F-FDG PET)-computed tomography (CT) scan for staging urinary bladder cancer. The study also sought to determine the effect of 18F-FDG PET/CT on management decisions and its implications for patient care. Methods A total of 133 patients with bladder cancer who had both conventional imaging and 18F-FDG PET/CT for initial staging were identified. All 18F-FDG-PET/CT findings were classified as true positive, true negative, false positive, or false negative based on their potential to impact the intent of treatment. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated using the standard definition. Furthermore, the rate of change in therapy intent was determined for the entire sample and for subgroups with non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC) patients. Results The overall concordance rate between PET/CT and conventional imaging was around 54%. On conventional images, 18% of patients had localized disease, which was upstaged in 6.8% of cases using 18F-FDG PET/CT. Pelvic lymph node involvement was detected in 18.8% of cases using conventional imaging, which was downstaged to localized disease in 4.5% of cases using 18F-FDG PET/CT. While 63.2% of patients had systemic disease on a CT scan, 24.7% of cases were downstaged using PET/CT. Overall, the rate of change in therapy intent was 26.3% for the entire sample, 24.5% for NMIBC subgroup, and 27.3% for MIBC patients. Conclusions The study found that 18F-FDG PET/CT is an effective and accurate tool for staging bladder cancer in newly diagnosed patients. Approximately one quarter of patients had a change in management intent based on 18F-FDG PET/CT results. The study suggests that PET/CT should be used as a standard for newly diagnosed patients, but more research is needed to confirm this.

Abstract Background Sildenafil was first prescribed for angina pectoris and then for erectile dysfunction from its effects on vascular smooth muscle relaxation and vasodilatation. Recently, sildenafil has been proposed for congenital heart diseases induced pulmonary hypertension, which constitutes a huge burden on children's health and can attribute to fatal complications due to presence of unoxygenated blood in the systemic circulation. Therefore, our meta-analysis aims to further investigate the safety and efficacy of sildenafil on children population. Methods We searched the following electronic databases: PubMed, Cochrane CENTRAL, WOS, Embase, and Scopus from inception to April 20th, 2022. Randomized controlled trials that assess the efficacy of using sildenafil in comparison to a placebo or any other vasodilator drug were eligible for inclusion. The inverse variance method was used to pool study effect estimates using the random effect model. Effect sizes are provided in the form of mean difference (MD) with 95% confidence intervals (CI). Results Our study included 14 studies with (n = 849 children) with a mean age of 7.9 months old. Sildenafil showed a statistically significant decrease over placebo in mean and systolic pulmonary artery pressure (PAP) with MD -7.42 (95%CI [-13.13, -1.71], P = 0.01) and -8.02 (95%CI [-11.16, -4.88], P

Abstract Background Monkeypox is a zoonotic viral infection first reported in May 2022. Monkeypox cases present with prodromal symptoms, rash, and/or systemic complications. This study systematically reviews the monkeypox cases presented with any cardiac complications. Methods A systematic literature search was done to locate papers that discuss any cardiac complications associated with monkeypox; then, data were analyzed qualitatively. Results Nine articles, including the 13 cases that reported cardiac complications of the disease, were included in the review. Five cases previously had sex with men, and two cases had unprotected intercourse, which reveals the importance of the sexual route in disease transmission. All cases have a wide spectrum of cardiac complications, such as acute myocarditis, pericarditis, pericardial effusion, and myopericarditis. Conclusion This study clarifies the potential for cardiac complications in monkeypox cases and provides avenues for future research to determine the underlying mechanism. Also, we found that the cases with pericarditis were treated with colchicine, and those with myocarditis were treated with supportive care or cardioprotective treatment (Bisoprolol and Ramipril). Furthermore, Tecovirimat is used as an antiviral drug for 14 days.

Abstract Introduction Thyroid nodules are highly prevalent in the general population; therefore, it is crucial to discriminate benign from malignant nodules. A practical thyroid imaging reporting and data system (TI-RADS) for thyroid nodules and ultrasound elastography are valuable tools not only for characterization of nodules but also for the selection of tumors for fine-needle aspiration cytology (FNAC). Objective This study aimed to evaluate the diagnostic accuracy of US evaluation in the prediction of malignant thyroid nodules and evaluate the role of the elastography score, strain ratio (SR), and the TI-RADS scoring system as non-invasive tools in differentiation between malignant and benign thyroid nodules. Material and methods A total of 1269 patients were evaluated between February 2017 and April 2020 by a single expert thyroid ultrasound operator. The final diagnosis was achieved from cytological and/or histological evaluation and follow-up for at least 1 year. Results There were 1088 females and 181 males with a mean age of 44 ± 10 SD. The final diagnosis was 1197 benign nodules and 72 malignant nodules. Most malignant nodules were scored elastography score 4 (83.3%) and TI-RADS category 5 (86.11%). We found that nodules with antero-posterior to transverse (A-P/T) diameter > 1, have 21 times more risk to be malignant than those with A-P/T diameter

We present a simple surgical technique aiming to improve urine outflow through the common urogenital sinus in cloaca and facilitate drainage of existing hydrocolpos. The study included three cases of cloaca with associated hydrocolpos that were operated during the period 2022 through 2023. The patient is placed in the prone position for a standard posterior sagittal anorectoplasty. The distal rectal fistula is severed flush with the vagina/sinus leaving an open defect in the posterior wall of the vagina/sinus. The defect is then widened distally via a vertical incision (∼1 cm) through the posterior wall of the common urogenital sinus toward but not reaching the perineum. This vertical defect is then closed horizontally displacing the posterior vaginal wall downwards toward the perineum (posterior sinuplasty). The postoperative recovery was uneventful in the three cases. Adequate drainage of hydrocolpos was confirmed by imaging at follow-up, as well as improvement of upper urinary tract dilatation. In selected cases of cloaca, posterior sinuplasty is a simple procedure that can be applied during anorectoplasty to provide effective drainage of associated hydrocolpos.

Clobetasol propionate (CP) is a super potent corticosteroid widely used to treat various skin disorders such as atopic dermatitis and psoriasis. However, its utility for topical application is hampered due to its common side effects, such as skin atrophy, steroidal acne, hypopigmentation, and allergic contact dermatitis. Microsponge is a unique three-dimensional microstructure particle with micro and nano-meters-wide cavities, which can encapsulate both hydrophilic and lipophilic drugs providing increased efficacy and safety. The aim of the current study is to prepare and optimize clobetasol-loaded microsponges. The emulsion solvent diffusion method is used for the preparation of ethylcellulose (EC)-based microsponges. The impact of various formulation variables on microsponge's properties includes; drug: polymer ratio, polyvinyl alcohol (PVA) quantities, the volume of external phase, and stirring rates investigated. The microsponges were characterized in terms of particle size, product yield, CP entrapment %, and in-vitro drug release behavior. The results report that increasing EC concentration led to a significant increase in particle size, with a decrease in product yield and drug entrapment %. Increasing stirring speed or external aqueous volume or PVA w/v % caused a non-significant decrease in production yield and CP entrapment % but showed a significant decrease, and increase in particle size, respectively. Finally, it was concluded that the ability to use ethylcellous as a Msg polymer matrix to prepare uniform, highly porous particles was confirmed by microscope observation and compatibility with CP.

Introduction Hyaluronic acid (HA) is a widely accepted agent most commonly used as a dermal filler in facial aesthetic/cosmetic medicine. More recently, HA has been utilized for gluteal augmentation. The common side effects of HA injection are often minor and self-limiting. HA migration is a very rare complication. Case Report We describe a rare case of HA buttock injection migration in a transgender patient, appearing as a superficial lump on right thigh representing a diagnostic dilemma. We highlight the need of a clinical suspicion and discuss the appropriate investigations for guided management of such patients. Conclusion It is essential for reporting radiologist to be aware of the commonly used injectable fillers, their complications, and imaging findings to avoid misdiagnosis and guide optimal patient management.

In this study, the soil has been numerically modeled as the Mohr-Columb model because it is simple to capture essential features of soil behavior. Plaxis 2D software program has been used for modeling. The dynamic analyses depend on some data, such as grain size gradation for materials, stiffness and water level. This data has been used in the calculation process. Simple applications have been chosen to calculate the relations. The program computes entered data automatically. Earthquakes result in dynamic loading on soil which has a significant effect on the soil properties. The model is formed of five soil layers. Sands and mud deposits covered the area and Delta also. Some of the study results can be estimated by using the modeling method. The applied load value is 100 kN/m2. The amplification factor (S %) to the soil in the study area is 108 % when soil is without the foundation load and 150 % when soil with foundation load. Thus, the soil is classified as type – D (Moderate) and no liquefaction is expected in the results, but subduction or landslide, so piling foundations are recommended within the area of study. As well, numerical modeling is recommended in several locations in Egypt to obtain suitable areas for the foundation constructions.

Yield losses of bread wheat due to crown rot can be more severe when drought conditions occur during the grain-filling period. Root architecture characteristics are important for soil exploration and below-ground resource acquisition and are essential for adaptation to water-limited environments. Traits such as root angle, length and density have been strongly associated with acquisition efficiency and contribute to yield stability of the crop. The impact of crown rot pathogens on wheat root architecture is poorly understood. We examined differences in root angle, length and number, as well as dry root weight of the crown rot-susceptible bread wheat cultivar, Livingston inoculated with one of two crown rot pathogens Fusarium culmorum or Fusarium pseudograminearum in a transparent-sided root observation chamber. Significant adverse impacts on plant health and growth were revealed by visual discolouration of the leaf sheaths; fresh and dry shoot weight; leaf area of the oldest and the youngest fully expanded leaf and leaf number. Values of most recorded root system measurements were reduced when inoculated with either F. culmorum or F. pseudograminearum. In contrast, root angle was increased in the presence of F. culmorum but was not significantly changed by F. pseudograminearum. The development of whiteheads and grain losses in bread wheat caused by crown rot have previously been associated with blockages of the vascular systems. The method employed here was able to identify differences in the pathogen impacts on roots, which were not detected using previous systems. This research indicates that in the presence of F. culmorum and F. pseudograminearum infection, not only reductions in the size and biomass of the shoot system but also changes in the length, biomass and architecture of the root system could play an important role in yield loss.

Objectives To estimate the economic costs, health-related quality-of-life outcomes and cost-effectiveness of subthreshold micropulse laser (SML) versus standard laser (SL) for the treatment of diabetic macular oedema (DMO) with central retinal thickness (CRT) of

لقد توسَّع في العقود الأخيرة دور الحكومات في دعم وتمويل مُؤسَّسات التعليم حول العالم؛ وذلك لما للتعليم من أهمية في تطوير الموارد البشرية وازدهار الدول، وتختلف الدول في أساليب وأنماط وطرُق تمويل المدارس والجامعات. وتهدف هذه الدراسة الوصفية إلى اكتشاف واقع تمويل مُؤسَّسات التعليم العامة في المملكة العربية السعودية، الولايات المتحدة الأمريكية، جمهورية ألمانيا الاتحادية، بالإضافة إلى التعرُّف على واقع تمويل التعليم في أربع من الدول الإسكندنافية؛ وهي السويد، النرويج، آيسلندا ومملكة الدانمارك. وقد وجدت الدراسة اختلافات في طرُق التمويل بين دول الدراسة، كما وجدت الدراسة أن هناك اختلافًا في طرُق تمويل المدارس العامة والجامعات العامة في الولايات المتحدة وألمانيا، بينما تُشير نتائج الدراسة إلى أن هناك تقارُبًا في طرُق التمويل بين المدارس العامة والجامعات العامة في كلٍّ من المملكة العربية السعودية ومُعظم الدول الإسكندنافية.

Purpose To study the incidence and sequelae of macular edema after Panretinal photocoagulation (PRP) for the treatment of proliferative diabetic retinopathy (PDR). Patients and Methods A prospective interventional clinical study included 42 eyes treated by PRP, for proliferative diabetic retinopathy over three sessions on three consecutive weeks. Baseline and 1-month postoperative data were collected including best-corrected visual acuity, detailed fundus examination and Spectral Domain Optical Coherence Tomography Macula (SD-OCT); to assess the Central Subfield Macular Thickness (CSMT) using the ETDRS Map. Results Forty-two eyes of 31 patients were included in the study with mean duration of diabetes of 16.9±5.7 years and mean HbA1c of 9.1±1.4. Mean pre-PRP vision was 0.44±0.2 log units, which improved to 0.41±0.2 log units (P=0.6). Mean pre-laser CSMT was 245.6±25.5 µm, which increased to 265.5±33.5 µm at 1-month follow-up after PRP (P=0.003). Four eyes (9.5%) had CSMT more than 300 µm with intraretinal edema. The mean change and percentage of change from baseline in CSMT between those patients and remaining patient were statistically insignificant (P=0.055 and 0.115 respectively). Changes in CSMT and changes in Log MAR BCVA at 4-week follow-up were inversely correlated. Conclusion Macular edema can be an unavoidable side effect of PRP especially in cases with baseline increased macular thickness. Vision is mostly not affected by PRP, however, changes in vision may be directly affected by macular thickness post-PRP.

Water buffaloes (Bubalus bubalis) are mainly distributed in tropical and subtropical countries that include the Indian sub-continent and some Mediterranean countries such as Egypt. The transition period is the most stressful period for buffaloes, and it is considered as a turning point in the productive cycle from one lactation to the next and includes different metabolic, physiological, and nutritional changes. Metabolic disorders are common causes of lower productivity in buffaloes. Of these metabolic disorders, ketosis and hypocalcemia are most prevalent. This study aimed to study the ketosis- and hypocalcemia-related biochemical changes during the transition period and their impacts on the postpartum reproductive fertility in Buffaloes. Out of 120 total number of examined buffaloes, 40 buffaloes were used in this study; control group (n=10), hypocalcemia-affected (n=15), and ketosis-affected group (n=15). All buffaloes were subjected to thorough clinical and gynecological examination. Both urine and blood samples were collected from all groups. The amounts of ketone bodies were detected in urine. Biochemical parameters were evaluated including concentrations of glucose, triglycerides, cholesterol, non-esterified fatty acids (NEFA), calcium, phosphorus, sodium, potassium, albumin, total protein, urea and progesterone hormone (P4) in blood the following time-points (2-weeks prepartum, 1-week prepartum, partum, 1-week postpartum, and 2-weeks postpartum). Both hypocalcemia- and ketosis affected buffaloes had lower glucose, phosphorus, sodium and albumin and higher NEFA than control group. Hypocalcemia-affected buffaloes showed lower calcium and higher total protein than control group, while, ketosis-affected buffaloes showed lower cholesterol and total protein than control group. Moreover, metabolic disorders negatively affected the reproductive performance. Both ketosis and hypocalcemia significantly prolonged the duration to first estrus, increased both the number of days-open and the number of services per conception

In this study, a numerical investigation of the uncooled polycrystalline concentrated photovoltaic (CPV) module was established using ANSYS software. The main objective is to estimate the maximum allowable solar concentration ratio (CR) at which the CPV module can safely operate without overheating. The numerical model was validated using data from the literature, resulting in a very good agreement. The thermal and electrical performance of the CPV module was studied at different ambient temperatures (0, 10, 20, 30, and 40 °C), wind speeds (1, 2, 3, 4, and 5 m/s), and CR number of (1.0,1.5, and 2.0 suns). This smaller CR can be achieved using a compound parabolic concentrator (CPC). The CPV system can safely operate when CR ranges from 1.0 to 1.5 suns, (1 Sun = 1000 W/m2), at all studied values of ambient temperatures and wind speeds. However, increasing the CR up to 2.0 makes results in a safe operation at wind speed values from 3 to 5 m/s. Further, the electrical efficiency increases rapidly by increasing the wind speed from 1 to 2 m/s and this increase gradually drops by growing the wind speed from 3 to 5 m/s. Furthermore, the minimum solar cell efficiency reached 12.56% at CR of 2.0 and 1 m/s. The highest heat dissipation from the CPV module is occurred at the lower ambient temperature and gradually decreases as wind speed rises.

Dystocia is a critical obstetrical problem in farm animals and is classified into maternal or fetal dystocia. The maternal causes of dystocia include different causes such as uterine torsion (UT), failure of cervical dilation (FCD), and uterine inertia (UI). Maternal dystocia induces massive oxidative stress due to increased production of free radicals with high levels of malondialdehyde (MDA). Little information is available on oxidants and antioxidant biomarkers and blood lactate (bLac) in parturient buffaloes with maternal dystocia. The current research aimed to clarify different causes of maternal dystocia in buffaloes and the association between the oxidative stress of parturient buffaloes and different types of maternal dystocia. Thirty-five parturient buffaloes were included in this study. Parturient buffaloes included normal parturition (NP; n=7), UT (n=23), FCD (n=4), and UI (n=1). Ten-ml blood samples were collected via jugular vein puncture into two tubes; plain vacutainer tubes for separation of serum to measure bLac and heparin coated vacutainer tube for separation of plasma for determination of MDA, glutathione peroxidase (GPx), and total antioxidant capacity (TAC). The results revealed that the major cause of maternal dystocia in the included buffaloes was UT. The UT was commonly post-cervical, clockwise, and > 180°. UT negatively affected both dam survival and calf viability. In addition, evaluation of oxidants and antioxidants biomarkers indicated that maternal dystocia causes more oxidative stress added to physiological stress of calving. This study found that, 4-days post-treatment period was not sufficient to resume antioxidant defense mechanism in UT buffaloes as no significant changes had been detected throughout the sampling period after treatment of UT. Moreover, evaluation of both GPx and bLac indicated their possible detection as indicators for prognosis of UT cases, where the concentration of GPx was significantly lower and the concentration of bLac was significantly higher in dead/culled buffaloes with UT.

Introduction. Labral tears (LT) can present with hip or groin pain. Investigation of LT is typically with Magnetic Resonance Arthrography (MRA). The injection of contrast for MRA can lead to fluid signal intensity/oedema on fluid sensitive sequences within the iliopsoas muscle and tendon complex masking the diagnosis of iliopsoas tendinopathy, which may present with similar symptoms. The aim of this study was to identify the presence of iliopsoas oedema in young adult patients being investigated for LT. Material and methods. We performed a retrospective search of our radiology system for the word ‘labral tear’ in the reports of patients who had MRI between 2012 to 2018. Patients under the age of 40 years who underwent high resolution dedicated hip MRI were included in our study. From this database, we then used a keyword search ‘strain and (o)edema’ to identify cases of iliopsoas pathology and analysed the results. Results. We identified 1151 consecutive cases of high resolution hip MRI with a suspected labral tear. 503 patients under the age of 40 years were included in our study with the average age of 27 years. Of the 503 patients within our cohort, searching for the word ‘strain’ identified 48 (9.5%) cases. Of these, 26 (5.3%) patients had iliopsoas oedema with a labral tear. 22 (4.4%) patients had iliopsoas oedema without a labral tear. Conclusion. Our study shows that 4.4% of patients undergoing MRA have no labral tears but iliopsoas oedema. Patients should undergo MRI to exclude iliopsoas strains before MRA.

The density profile of the QCD flux tube is investigated within the framework of the L¨ uscher-Weisz (LW) string action with two boundary terms. The transverse action profile and potential between static quarks are considered using Wilson’s loop overlap formalism at zero temperature in SU(2) Yang-Mills theory. We find the predictions of the LWstring matching the lattice data for the width of the energy-density and Q ¯Q potential up to a small color-source separation of R = 0.32 fm.

Pediatric Differentiated Thyroid Cancer (pedDTC) is a rare pediatric malignancy with an increasing incidence over time. To date, there is a paucity of literature specifically addressing pedDTC within the context of Middle Eastern ethnicity. This retrospective study aimed to assess the risk-stratifying factors for overall survival (OS) and event-free survival (EFS) in pediatric DTC patients from Iraq and Jordan. The medical records of 81 patients from two tertiary cancer institutes were retrieved. Kaplan–Meier analysis was employed to investigate OS and EFS, and the Cox proportional hazards model was employed to estimate hazard ratios. All patients underwent surgery and radioactive iodine therapy, with a median age of 14 and an interquartile range of 12–15. Lymph node involvement was observed in 55% of cases, while distant metastases were present in 13.5%. After a median follow-up period of 68 months, the 10-year survival rate was determined to be 94%, while the 10-year EFS rate was 58%. EFS was negatively impacted by cervical lymph node metastases and early age of diagnosis (p ≤ 0.01, each). Therefore, pediatrics with initial cervical lymph node metastases and those diagnosed before puberty tend to experience poorer EFS, which may justify the need for more aggressive management plans.

Background and Objectives: Post-Stroke Fatigue (PSF) is a complex, multidimensional, debilitating condition that affects almost half of all stroke survivors. This study explored the perceptions of physiatrists, physiotherapists, and occupational therapists about PSF and their experiences in managing patients with PSF in Saudi Arabia. Materials and Methods: Qualitative semi-structured interviews were conducted with participants from three different groups: eight physiotherapists (PTs), eight occupational therapists (OTs), and eight physiatrists (DRs). Using purposive sampling, participants with at least one year of experience in the field of PSF management were invited to take part. The data were analysed using inductive thematic analysis. Results: Twenty-four health care participants (eight PTs, eight OTs, eight DRs) were recruited. Five overarching themes encompassing various subthemes and sub-subthemes were generated: ‘knowledge about post-stroke fatigue’, ‘diagnosing post-stroke fatigue’, ‘treatment approach’, ‘lack of awareness about post-stroke fatigue’, and ‘domains to improve’. The data indicated that participants used various strategies to manage PSF, including dietary changes, sleep hygiene, exercise, and energy conservation. Conclusions: Participants acknowledged that they lacked PSF-related management skills, despite possessing adequate knowledge about the management of stroke. Their openness to participating in activities that would improve their ability to diagnose and manage PSF was particularly striking.

Background: The variation in the reported vaccine safety and effectiveness could contribute to the high rates of vaccine hesitancy among the general population and healthcare workers in areas where monkeypox (mpox) is circulating. In this review, our objective was to evaluate the safety, immunogenicity, effectiveness, and efficacy of the mpox vaccines. Methods: An extensive search for articles across multiple databases was performed, including searching six databases (PubMed Central, PubMed Medline, Scopus, Web of Science, Cochrane, ProQuest), two pre-print databases (European PMC Preprint and MedRxiv), and Google Scholar. Results: A total of 4290 citations were retrieved from the included databases. Following the removal of duplicates and the initial screening of records, a total of 36 studies were included into the analysis. Additionally, we identified five more studies through manual searches, resulting in a total of 41 eligible articles for qualitative synthesis. The study findings revealed that mpox vaccines demonstrate the ability to generate adequate antibodies; however, their effectiveness may decrease over time, exhibiting varying safety profiles. Most of the included studies consistently reported substantial levels of effectiveness and efficacy against mpox. Interestingly, the number of vaccine doses administered was found to influence the degree of immunogenicity, subsequently impacting the overall effectiveness and efficacy of the vaccines. Furthermore, we found that smallpox vaccines exhibited a form of cross-protection against mpox. Conclusions: Vaccines can be used to prevent mpox and effectively control its spread.

Abstract Background Vaginismus is a female sexual dysfunction affecting the quality of women and the couple’s relationship. It is considered the main feminine cause of unconsummated marriage in Egypt. The study aims in assessment of comorbid psychiatric disorders, personality disorders, and levels of alexithymia among a sample of women with vaginismus. It is a case-control study where 30 women diagnosed with vaginismus following up in the psychosexual clinic in Ain Shams University Hospitals were enrolled in the study in comparison to 30 controls. Assessment was done based on the socio-demographic data, Toronto Alexithymia scale (TAS-20), Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I), and Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). Results It was found that women having vaginismus had significant below university level of education (P = 0.026) together with their partners (P = 0.006). It was also found that women having vaginismus are showing high levels of alexithymia (p < 0.001), more than one anxiety and/or depressive disorder (P = 0.032) in comparison to the control group. Also, borderline personality disorder/traits and avoidant personality traits were significantly more frequent among cases (P = 0.026, P = 0.001, and P = 0.045 respectively). Moreover, it was found that having two or more of either of rigidity, perfectionism, dramatization, mood swings, and impulsivity was significantly more frequent among cases (P < 0.001) showing a unique personality pattern of women with vaginismus. Conclusions Women with vaginismus were having higher levels of alexithymia, more developing anxiety, and depressive disorders than controls and they have specific personality characteristics.

Background: By the end of 2019, coronavirus identified as a cause of pneumonia cases in Wuhan city, China. In February 2020, World Health Organization reported the disease COVID-19, which means for coronavirus disease 2019. There is a great need for rapid and accurate diagnostic tools to aid in triage of severe cases.Aim of the work: Our study aimed to evaluate some biochemical and hematological parameters in COVID-19 patients and its relation to severity.Patients and methods: It was a case control study, included 200 individuals which had classified into two groups. Covid group: 100 patients with Positive PCR COVID-19 infection. Control group: 100 individuals matched for age and sex and complained of diseases apart from COVID-19 confirmed by negative PCR. All patients were chosen from outpatient clinic and inpatient of Chest department of Al-Azhar University Hospital at New Damietta from March 2021 to January 2022. Evaluation of complete blood picture with differential count, inflammatory profile as CRP, ferritin and LDH together with serum protein electrophoresis were done. Results: We found that there was markedly difference between COVID-19 group and control group as regards to WBCs, Lymphocyte and PNL/ Lymph ratio. It also found that in COVID-19 group D-Dimer, serum ferritin and LDH were highly significant increase in COVID-19 group compared to control group. Finally, serum protein electrophoresis shows significant changes in COVID-19 group compared to control groups and also shows significant correlation with severity of cases.Conclusion: We concluded that laboratory tests may serve as adjuvant in diagnosis and following up of COVID-19 cases and using of serum protein electrophoresis may aid in early diagnosis and correlate with severity.

The present study investigated the effects of epidermal growth factors (EGF) and/or β-Mercaptoethanol (βME) supplementations to oocyte maturation, fertilization, and culture media on the buffalo in vitro embryo production. The ovaries were collected and transferred within 2 h to the laboratory. The cumulus oocytes complexes were aspirated from 3 to 8 mm diameter follicles. Firstly, EGF; 0, 10, 20, or 50 ng/mL or βME; 0, 25, 50, 100, or 200 μM were supplemented to the in vitro maturation (TCM-199), fertilization (IVF-TALP), or culture (IVC: SOF) media. Our results revealed that supplementing EGF (20 ng/mL) to the TCM-199, IVF-TALP, or SOF media could efficiently improve the growth rates and development of buffalos' embryos, while EGF (50 ng/mL) could stimulate the embryo production only after treatment of the IVF-TALP /or SOF media, but not the IVM medium. However, βME was less efficient than EGF; it stimulated the growth rates of buffalo embryos when supplemented with the maturation and fertilization (IVF-TALP) media in a 50 μM concentration. Secondly, combined EGF (20 ng/mL) and βME (50 μM) were supplemented to the maturation media as effective concentration. The combined treatment of EGF (20 ng/mL) and βME (50 μM) showed no significant enhancing effect on the buffalo embryos compared to each alone. For future perspectives, further study is required to examine the effects of combined EGF and βME on the maturation and fertilization of buffalo oocytes at different categories of age and seasonal localities.

The aim of the present study was to evaluate the efficacy of pudendal nerve block as an alternative procedure to epidural analgesia for penile relaxation in male goats. Five healthy male goats were subjected to pudendal nerve block and lumbosacral epidural analgesia with a twoweeks interval as a washing period. Bilateral pudendal nerve block was performed using 1% of lidocaine hydrochloride (HCl) by ischiorectal fossa approach. Lumbosacral epidural analgesia was performed using 1% of lidocaine HCl in the lumbosacral space. Nociception was investigated by pinprick. Time to the onset and duration of the anti-nociception effect in the perineal region were recorded. Area of desensitization and penile relaxation were observed. Incoordination, ataxia, and analgesic effects were carefully observed and recorded according to the scoring system before analgesic administration and at 5-, 15-, 30-, 60-, and 90-min after administration. Pulse rate, respiratory rate, and rectal temperature were recorded at 0-, 5-, 15-, 30-, 60-, and 90- min after administration. This study showed that both the pudendal nerve block and the epidural analgesia resulted in analgesic effects, however, the penile relaxation without manipulation was observed in 4 out of 5 male goats subjected to the pudendal nerve block. None of the male goats subjected to lumbosacral epidural analgesia showed penile relaxation, spontaneously. The time of onset was significantly earlier in the pudendal nerve block compared to the epidural analgesia, Moreover, the duration of action was significantly shorter in the pudendal nerve block compared to the epidural analgesia. Incoordination, ataxia, and recumbency were observed in 3 out of 5 male goats subjected to epidural analgesia. In conclusion, the pudendal nerve block is likely superior to the epidural analgesia for examination of the penis and surgical procedures on the male goat reproductive system in the standing position.

Introduction Percutaneous vertebroplasty is used for symptomatic osteoporotic fractures and osteolytic neoplasms. We performed a retrospective study to analyze the pattern of leaks in the two cohorts. Material and Methods Vertebroplasties performed over a 7-year period at a tertiary orthopaedic center were included in the study and divided into osteoporotic and neoplastic groups. The incidence and pattern of cement leaks in each group were documented and analyzed. Results There were 75 leaks of a cohort of 211 vertebroplasties with a relatively equal proportion in osteoporotic and neoplastic groups. The incidence of discal leaks was comparable between the two groups. Lateral and posterior leaks were more common in the neoplastic group. Conclusion We report the incidence and type of leaks in osteoporotic and neoplastic groups. Understanding the fracture pattern and preoperative management are both essential in preventing cement leakage. Using highly viscous cement or allowing the cement to harden prior to injection, with use of low pressure, decreases the risk and incidence of cement leakage.

Background and Aim: The reproductive performance of dairy cows is of a high economic value to maintain efficient and sustainable productivity. Postpartum anestrus is one of the major infertility problems that cause limitation of dairy cow reproductive performance and productivity. The previous studies have reported using a polyherbal formulation for different purposes, including reproductive performance. This study was conducted to examine the efficacy of polyherbal formulation administration on the reproductive performance of cows and to establish the oral administration of polyherbal formulations as a safe, effective, and economic treatment for dairy cows with postpartum anestrus due to nutritional disorders, negative energy balance, high milk production, and/or heat stress. Materials and Methods: A total of 14 dairy cows with postpartum anestrus were randomly divided into two groups, which were subjected to oral administration of distilled water that served as the control (Ctrl; n=5) or polyherbal treatment (polyherbal treated; n=9) for two shots of treatment (each for 3 successive days) with a 10-day interval. Blood sampling and ultrasonography were performed before treatment and after the first and second shots of treatment. Progesterone (P4) assay was also performed. Results: The estrus induction rate was 66.7% after the first shot of treatment in the polyherbal-treated group, which increased significantly to 88.9% after the second shot of treatment, compared with the Ctrl group (20%). The estrus response was confirmed by ultrasonography and P4 hormone assay, wherein the polyherbal treatment significantly increased the P4 concentration in the polyherbal-treated group after the second shot of treatment compared to that before treatment and in the Ctrl group at all time points. On pregnancy diagnosis, the treated dairy cows showed conception rates of 66.7% and 20.0% in the polyherbal-treated and Ctrl groups, respectively. In contrast, the concentration of malondialdehyde, an oxidative stress marker, and the total antioxidant capacity remained unchanged between both groups before and after treatment. Conclusion: The polyherbal formulation containing tubers of C. rotundus, M. pterygosperma, rhizome of Z. officinale, and A. cepa has the potential to induce estrus response and luteal activity in dairy cows and is a possible treatment for ovarian inactivity in dairy farms.

Abstract Background Cystic fibrosis (CF) is the most common life-limiting autosomal recessive disease among people in the USA and Europe with increased prevalence in Egypt. Affected children are in danger of acute kidney injury and the development of chronic renal disease through exposure to multiple nephrotoxic agents. N-acetyl beta-D-glucosaminidase (NAG) is a lysosomal enzyme present in high concentrations in the proximal tubular cells, thus raising urinary NAG levels to reflect tubular dysfunction. The aim of our study is to detect the role of the urinary NAG enzyme in the early detection of renal impairment in CF patients. This cross-sectional study enrolled 40 CF patients diagnosed in the CF Clinic in Children’s Hospital of Cairo University. They were age- and sex-matched to 40 healthy controls. All patients had glomerular filtration rate (GFR), serum creatinine, blood urea nitrogen (BUN), albumin/creatinine (A/C) ratio measured, urine analysis, urinary NAG enzyme using enzyme-linked immunosorbent assay (ELISA), and renal ultrasound (U/S) were done. Results Our study showed high levels of urinary NAG in cases with a significant difference between cases and controls (P value < 0.001). There was a significant correlation between urinary NAG enzyme elevation and A/C ratio in urine, nephrotoxic drugs administration, and duration of disease (P value = 0.002, 0.005, 0.019), respectively. Conclusion Our study suggested that the NAG enzyme is a good early detector of renal impairment in CF patients before the conventional laboratory assays become deranged.

Breaking bad news is an intrinsic aspect of physicians’ clinical practices. This study aims to investigate how Saudi physicians manage the process of communicating bad news and explore potential differences in breaking bad news practices between young physicians (interns) and their older colleagues. From 1 March to 15 April 2023, ok an anonymous online cross-sectional survey was conducted to explore the communication practices of Saudi physicians concerning breaking bad news using the Communicating Bad News Questionnaire. The physicians were recruited through convenience and snowball sampling methods, and the survey questionnaire was distributed on various social media platforms, including Facebook, Twitter, LinkedIn, and WhatsApp. Data were analyzed using R version 4.2.1. A total of 782 physicians were included in this study. Male physicians represented 50.9% of the participants. Three-quarters (74.7%) were aged 25–30 years. The largest proportion of physicians (45.3%) were interns, followed by junior residents (22.9%), senior residents (11.0%), and specialists (6.5%). The median years of experience was 1.0, ranging from 0 to 45 years. Regarding the place of work, most physicians (86.6%) worked in hospitals, while 13.4% worked in primary healthcare centers. A total of 14.8% said they were not comfortable with discussing patients’/relatives’ issues (20.60 among interns vs. 10.50% among non-interns, χ2 = 27.50, p = 0.0001), 66.6% reported being trained to break bad news (59.60% among interns vs. 72.40% among non-interns, χ2 = 14.34, p = 0.001), 59.1% reported breaking bad news to the patient, 37.9% reported to the family, and 3.1% reported to both, with no significant difference between interns and non-interns. A substantial proportion of physicians reported feeling uncomfortable discussing sensitive issues with patients and their relatives despite having received training to deliver bad news and being willing to communicate bad news directly to patients. Notably, our analysis identified a significant disparity between intern and non-intern physicians, particularly in terms of their comfort level in addressing patient-related concerns and access to breaking bad news training.

This study was achieved to investigate the accumulation of some heavy metals included: Cadmium, Lead and Nickel in the tissues (gill, intestine, liver, muscles and skin)of Silurus triostegus Heckel, 1843 (Siluriformes, Siluridae) and its larval stage of the nematode Contracaecum sp. (Rhabditida, Anisakidae). As well as to assess the infection patterns of Contracaecum among S. triostegus specimens which were purchased fresh from the local market in Baghdad. One hundred and nine nematodes specimens in larval stage were recovered from the fish host; the overall prevalence of Contracaecum sp. was 38.6%. The sex of the host was not significantly (P ˃ 0.05) associated with the infection of this nematode. Results showed that the overall mean intensity of Contracaecum sp. was 6.41; mean intensity did not differ significantly (P ˃ 0.05) between the fish sexes.The lead (Pb) was the only element detected in all fish tissues investigated as well as in the parasite, while the cadmium and nickel elements were not detected in all specimens. Skin and muscles of the fish, as well the parasite Contracaecum sp. contained the lowest lead levels compared to other fish tissues (gill, intestine and liver), although no significant differences were noticed among all investigated tissues and the parasite regarding the concentration of Pb.

Abstract Background The ultimate treatment goal of schizophrenia is regaining patients’ pre-morbid function. Results Ninety-three outpatients with schizophrenia, diagnosed according to the criteria of Diagnostic and Statistical Manual of Mental Disorders—fourth edition (DSM-IV), were recruited, of whom 35 patients (37.6%) had achieved the remission severity criteria, whereas 58 patients (62.4%) failed to fulfill the criteria for remission. The functional aspects were examined by the Global Assessment of Functioning scale (GAF) and the Social Functioning Questionnaire (SFQ). Predictors of outcome were examined by applying binary logistic regression analysis. Patients who fulfilled those specific criteria for remission showed a favorable outcome in the assessed areas, regarding GAF and social functioning in society. Lack of judgment or insight item of PANSS showed significantly good functional outcomes. Conclusion The results suggest that the remission concept has important implications for the treatment of schizophrenia. Remission seems to be associated with better functional capabilities. However, this does not necessarily mean that remitted patients have “adequate” functioning, especially regarding the social skills domain.