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Ahmad A Elshafei,1,2 Stephani A Flores,2 Ramandeep Kaur,3 Ellen A Becker3 1Department of Quality Operations & Population Health, Advocate Health, Green Bay, WI, USA; 2Department of Respiratory Care, Rush University Medical Center Chicago, IL, USA; 3Department of Cardiopulmonary Sciences, Rush University, Chicago, IL, USACorrespondence: Ahmad A Elshafei, Department of Quality Operations & Population Health, Advocate Health, Green Bay, WI, USA, Email Ahmad.elshafei@aah.orgPurpose: Coronavirus disease 2019 (COVID-19) impacted outcomes of persons with chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD). This study investigated the differences in respiratory interventions, hospital utilization, smoking status, and 30-day readmission in those with COPD and COVID-19 based on hospital survival status.Methods: A retrospective cross-sectional study was conducted from February 2020 to October 2020 and included persons with COPD and COVID-19 infection. We examined respiratory interventions, hospital utilization and outcomes, and 30-day hospital readmission. Chi-square test analysis was used to assess categorical variables, and t-test or Mann–Whitney was used to analyze continuous data based on normality.Results: Ninety persons were included in the study, 78 (87%) were survivors. The most common comorbidity was hypertension 71 (78.9%) (p = 0.003). Twenty-two (24%) persons were intubated, from whom 12 (15%) survived (p < 0.001). There were 25 (32.1%) and 12 (100%), (p < 0.001) persons who required an ICU admission from the survivor and non-survivor groups, respectively. Among the survivor group, fifteen (19%) persons required 30-day hospital readmission.Conclusion: Persons with COPD and COVID-19 had a lower mortality rate (13%) compared to other studies in the early pandemic phase. Non-survivors had increased ICU utilization, endotracheal intubation, and more frequent application of volume control mode. Discharging survivors to long-term acute care facilities may reduce 30-day hospital readmissions.Keywords: chronic obstructive pulmonary disease, COVID-19, COPD, respiratory interventions, hospital utilization, hospital readmission, comorbidities

Reham Hammad,1 Asmaa A Elmadbouly,1 Inass Hassan Ahmad,2 Shaymaa A Mohammed,1 Nehal Farouk,3 Zahraa Futooh,4 Mohamed Omar Alfy,5 Sarah Abozaid,1 Eman F Mohamed,6 Fatma M Kotb,6 Alzahra Abdelbadea,7 Nora Seliem,7 Ahmed Elshafei,8 Alya Mashaal9 1Clinical Pathology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 2Endocrinology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 3Vascular Surgery Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 4General Surgery Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 5General Surgery Department, Al Zahraa University Hospital, Al-Azhar University, Cairo, Egypt; 6Internal Medicine Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 7Biochemistry Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 8Biochemistry and Molecular Biology Department, Faculty of Pharmacy for Boys, Al-Azhar University, Cairo, Egypt; 9Immunology, Zoology & Entomology Department, Faculty of Science for Girls, Al-Azhar University, Cairo, EgyptCorrespondence: Asmaa A Elmadbouly Tel +20 1011504476Email asmaaelmadbouly@azhar.edu.egBackground: The link between immune system and type 2 diabetes mellitus (T2DM) pathogenesis attracted attention to demonstrate the role of immune cells and their secreted cytokines in T2DM development and its subsequent foot complications.Objective: To investigate the relation between T Natural killer cell (TNK) %, Interleukin 4 (IL4) and Interferon gamma (IFN-γ) and diabetic foot infection (DFI) development in patients with diabetic foot ulcer (DFU).Patients and Methods: Ninety patients with diabetes were included in this work, divided as T2DM group (n=30), DFU group (n=30), and DFI group (n=30). TNK% was detected using flow cytometry. Serum IL4 and IFN-γ were measured by ELISA. Diabetes biochemical parameters were also analyzed.Results: Significant decrease was detected in TNK% and IFN-γ in DFI group compared to other 2 groups (P< 0.001). Significant decrease was detected in serum levels of IL4 in DFI group compared to T2DM group (P=0.006). IFN-γ/IL4 was significantly decreased in DFI compared to DFU group (P=0.020). There was a significant correlation of TNK% with both IL4 and IFN-γ (r=0.385, P< 0.001; r=0.534, P< 0.001, respectively). Significant negative correlation of TNK% with HbA1c and LDL was revealed (r=− 0.631, P< 0.001; and r=− 0.261, P=0.013, respectively), while a positive correlation was seen with HDL (r=0.287, P=0.006). A significant negative correlation of IL4 with HbA1c was found (r=− 0.514, P< 0.001;. As for IFN-γ, a significant negative correlation with HbA1c and LDL was detected (r=− 0.369, P< 0.001; r=− 0.229, P=0.030). TNK % and IFN-γ level showed negative correlations with disease duration/year (r=− 0.546, P< 0.001; r=− 0.338, P=0.001,respectively).Conclusion: Decline in TNK frequency has essential role in T2DM pathogenesis and subsequent foot complications. Downregulation of TNK% and IFN-γ level have potential roles in predicting infection of diabetic ulcer and are correlated with disease duration.Keywords: diabetic foot ulcer, diabetic foot infection, natural killer cell, interferon gamma, interleukin 4

Abstract Background Conservative treatments of post-dural puncture headache (PDPH) may be unsuccessful, and the relief that is provided is frequently insufficient. This study aimed to meticulously explore the analgesic efficacy of the sphenopalatine ganglion (SPG) block when administered alone or in conjunction with the greater occipital nerve block (GONB) for the purpose of treating PDPH and with the aid of transcranial Doppler (TCD) to evaluate the cerebral hemodynamics before and after the block. This study was conducted on 63 women with post-partum PDPH randomized into the following: control group (Group C = 21 participants), received conservative management; SPG block group (Group S = 21 participants), received conservative management with SPG block; and combined nerve and ganglion block group (Group NAG = 21 participants), received conservative management with SPG block and ultrasound guided GONB. Visual analog score (VAS), modified Lybecker score, and transcranial Doppler (TCD) measures were used to determine PDPH severity at 0 (baseline), 1, 6, and 24 h. Additionally, the three groups’ needs for EBP were noted. Results VAS and modified Lybecker scores at 1, 6, and 24 h were statistically significantly lower in S and NAG groups compared to the control group with no statistically significant difference between S and NAG groups. With TCD, the mean velocity (MV) was significantly lower at 1, 6, and 24 h compared to baseline reading in both S and NAG groups. Also, the pulsatility index (PI) was statistically higher at 1, 6, and 24 h compared to baseline readings in S and NAG groups. There was no statistically significant difference regarding the need for EBP. Conclusions In terms of headache relief or the need for EBP, there is no difference between individual SPG block or combined SPG block and GONB in the treatment of PDPH.

Abstract Background Migraine is one of the most prevalent and disabling primary headache disorders. Migraine has many triggers factors as stress and irregular sleep pattern. Medical study in Egypt is so stressful with great psychological and physical burden; hence medical students are vulnerable to migraine. This study aims to determine the prevalence, characteristics, degree of disability, and psychological stress associated with migraine among medical students at different Egyptian universities. Results The overall prevalence of migraine was 17.27%, more in female (76.86%) than male. Sleeping disturbance and stress were the most common triggering factors associated with migraine (94.4%, 81.4% respectively). The majority of students with migraine (89.65%) had high psychological distress as measured by Kessler Psychological Distress Scale (K10) with moderate to severe disorder, while 76.8% had moderate to severe disability as assessed by Migraine Disability Assessment Score (MIDAS). Female gender was a potential predictor associated with higher psychological distress. There is negative correlation between degree of disability and academic performance. Conclusion Migraine is prevalent among medical students, with female predominance. It is associated with high level of psychological stress, moderate to severe disability, and negative impact on lifestyle and academic performance of the students.

Abstract Background It has been postulated that COVID-19 has a substantial neuro-otological impact such as vertigo or dizziness that is rarely evaluated. The purpose of this research is to study the occurrence of vertigo (whether as presenting symptom or a sequela) and its etiological characteristics in patients with covid 19 infection and close contact. It is a cross-sectional study (convenient sample) conducted on patients that had a previous history of covid 19 infection and another group of contact individuals who presented with the sensation of vertigo. All the included participants underwent full neurological and otological examination, nasopharyngeal swab PCR to confirm COVID-19 infection and video nystgmograghy (VNG). Results it was included 44 participants, where 7 (15.9%) of the participants were post-COVID-19 patients and 37 (84.1%) were close contacts of COVID patients. It was found that 6(85.7%) of post-COVID-19 patients had vestibular neuritis (VN), and 1(14.3%) patient had Benign Paroxysmal Positional Vertigo (BPPV). 9(23%) of those in close contact had positive PCR for COVID infection, 6(66.7%) of them had VN, and the other 3 (33.3%) had BPPV. Conclusion Vertigo could be a possible complication or a presenting symptom in patients with COVID patients that is mainly attributed to peripheral vestibular dysfunction.

Abstract Background Hepatocellular carcinoma (HCC) is among the common cancers, but difficult to diagnose and treat. l-asparaginase has been introduced in the treatment protocol of pediatric acute lymphoblastic leukemia (ALL) since the 1960s with a good outcome and increased survival rates to nearly 90%. Moreover, it has been found to have therapeutic potential in solid tumors. Production of glutaminase-free-l-asparaginase is of interest to avoid glutaminase-related toxicity and hypersensitivity. In the current study, an extracellular l-asparaginase that is free of l-glutaminase was purified from the culture filtrate of an endophytic fungus Trichoderma viride. The cytotoxic effect of the purified enzyme was evaluated in vitro against a panel of human tumor cell lines and in vivo against male Wister albino mice intraperitoneally injected with diethyl nitrosamine (200 mg/kg bw), followed by (after 2 weeks) oral administration of carbon tetrachloride (2 mL/kg bw). This dose was repeated for 2 months, and after that, the blood samples were collected to estimate hepatic and renal injury markers, lipid profiles, and oxidative stress parameters. Results l-asparaginase was purified from T. viride culture filtrate with 36 purification folds, 688.1 U/mg specific activity, and 38.9% yield. The highest antiproliferative activity of the purified enzyme was observed against the hepatocellular carcinoma (Hep-G2) cell line, with an IC50 of 21.2 g/mL, which was higher than that observed for MCF-7 (IC50 34.2 g/mL). Comparing the DENA-intoxicated group to the negative control group, it can be demonstrated that l-asparaginase adjusted the levels of the liver function enzymes and the hepatic injury markers that had previously changed with DENA intoxication. DENA causes kidney dysfunction and altered serum albumin and creatinine levels as well. Administration of l-asparaginase was found to improve the levels of the tested biomarkers including kidney and liver function tests. l-asparaginase treatment of the DENA-intoxicated group resulted in a significant improvement in the liver and kidney tissues to near normal similar to the healthy control group. Conclusion The results suggest that this purified T. viride l-asparaginase may be able to delay the development of liver cancer and may be used as a potential candidate for future application in medicine as an anticancer medication.

Abstract MS (Multiple sclerosis) associated uveitis used to have limited phenotypes. Bilateral exudative retinal detachment has never been recognized as a pattern of MS-associated uveitis. We are reporting a patient with multiple sclerosis who presented initially with the usual pattern of intermediate uveitis and later developed bilateral exudative retinal detachment.