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Abstract Background The results of several studies assessing the effect of the glutathione S-transferase class Mu 1 (GSTM1) null variant on the genetic susceptibility of tobacco-related cancers have been conflicting. In this work, we aim to identify the impact of the deletion of GSTM1 on lung cancer risk among smokers. Methods This study was conducted on 20 patients diagnosed with primary lung cancer and 20 healthy individuals as a control group. They were subject to full medical history taking, complete clinical examination, and GSTM1 genotyping by PCR. Results Both studied groups were matched for age, sex, and smoking status. No statistically significant difference was exhibited between the frequency of GSTM1 positive and GSTM1 null in the studied population. No risk of lung cancer associated with GSTM1 null genotype was demonstrated between the patients and control group (n = 14/20 cases) (p = 0.110, OR = 2.852, 95% CI 0.777–10.467). Additionally, there was no association between the risk of lung cancer and the presence of the gene either in smokers (p = 1, OR = 1.8 and 95% CI 0.124–26.196) or non-smokers; (p = 0.063, OR = 4.4 and 95% CI 0.889–21.78). No statistically significant risk was found between the frequencies of GSTM1 null and the various histopathological types of lung malignancy. Conclusion The results of this work demonstrated no association between the occurrence of the GSTM1 null variant, even when stratified for smoking status, and the risk of lung cancer.

Abstract Background Globally, MAFLD becomes in the top list of causes of liver disease. Its effect ranges from steatosis, metabolic steato-hepatitis to MAFLD-related cirrhosis and hepatocellular carcinoma. There is a growing evidence that MAFLD-related HCC seems to be different from HCCs of other causes pathologically, so the purpose of our study was to assess the effect of MAFLD on the prognosis of HCC regarding outcome after management of HCC and survival rate in comparison to a group of patients with HCV-related HCC. Results Twenty-nine patients with MAFLD related HCC were included in group A, while 58 patients with HCV related HCC were enrolled as group B. Both groups were matched regarding age and gender. The mean age in group A and B was 58.86 (±8.47) years and 60/05(± 6.83) years respectively. Comparison between both groups regarding tumor burden and characteristics of HCC, type of management, and post intervention follow-up showed no significant statistical difference between both groups except for lymph node metastases which was higher in patients with HCV related HCC with p = 0.045. Also, a significant difference between both studied groups regarding AFP was detected; the median of AFP in MAFLD-related HCC was (7.2 ng/ml) but much higher in HCV-related HCC group (129.2 ng/ml) with p = 0.001. Conclusion Our data showed no significant difference between the two studied groups regarding outcome of HCC or survival rate except for AFP level before and after management which was higher in HCV patients related HCC. Although both of inclusion and exclusion criteria were strict to the criteria, so the number of participants in the research were not large enough; to our knowledge, this is the first study on MAFLD-HCC in Egypt and Africa. More studies on prospective bases are essentially needed to stand on solid conclusion about the nature and outcome of MAFLD-related HCC.

Abstract Background Persistent airway inflammation is a central feature of bronchiectasis. Arachidonate 15-lipoxygenase (ALOX-15) controls production of endogenous lipid mediators, including lipoxins that regulate airway inflammation. Mutations at various positions in ALOX-15 gene can influence airway disease development. We investigated association between ALOX-15,c.-292 C > T gene polymorphism and bronchiectasis unrelated to cystic fibrosis in Egyptian children. Also, lipoxin A4 (LXA4) level in bronchoalveolar lavage (BAL) was studied in relation to polymorphism genotypes and disease phenotypes determined by clinical, pulmonary functions, and radiological severity parameters. Methods This was an exploratory study that included 60 participants. Thirty children with non-cystic fibrosis bronchiectasis (NCFB) were compared with 30 age and sex-matched controls. ALOX-15,c.-292 C > T polymorphism was genotyped using TaqMan-based Real-time PCR. LXA4 was measured in BAL using ELISA method. Results There was no significant difference between patients and controls regarding ALOX-15,c.-292 C > T polymorphism genotypes and alleles (OR = 1.75; 95% CI (0.53–5.7), P = 0.35) (OR = 1; 95% CI (0.48-2), p = 1). BAL LXA4 level was significantly lower in patients, median (IQR) of 576.9 (147.6–1510) ng/ml compared to controls, median (IQR) of 1675 (536.8–2542) (p = 0.002). Patients with severe bronchiectasis had a significantly lower LXA4 level (p T polymorphism might be a protective genetic factor against bronchiectasis development and/or progression due to enhanced LXA4 production.

Abstract Background We recently adopted a guideline for chronic cough in children in the Egyptian health system. Adapting clinical practice guidelines (CPGs) to the local healthcare setting is a valid alternative to de-novo development that can improve their uptake and implementation without demanding a substantial drain on resources. The objective of this study was to adapt evidence-based recommendations from global high-quality CPGs for children with a chronic cough to suit the Egyptian healthcare context. Methods We followed the Adapted ADAPTE methodological framework for guideline adaptation. This process includes three phases: set-up, adaptation, and finalization. A guideline adaptation group (GAG) and an external review group including clinical content experts and methodologists conducted the process. Results The GAG adapted 10 sections of recommendations from three original CPG(s) including (i) the American College of Chest Physicians (ACCP) 2006–2020, (ii) the European Respiratory Society (ERS) 2019, (iii) the Korean Academy of Asthma, Allergy and Clinical Immunology (KAAACI) 2018. A set of CPG implementation tools was added to enhance implementability including an algorithm, a slide presentation for clinical diagnosis, investigations and treatment of chronic cough, patient education, and online resources. Conclusion The adapted CPG provides pediatricians and related healthcare workers with applicable evidence-based recommendations for chronic cough in children in Egypt. The project also highlighted the utility of Adapted ADAPTE and the invaluable collaboration between the clinical and methodological experts for the adaptation of pediatric national guidelines.

Optimum operation of power system network becomes of great importance to handle the problem of power shortage. Connecting renewable energy (RE) based distributed generators (DG) into electrical networks (EN) are spreading rapidly to earn more benefits environmentally and economically. This paper aims to optimally operate DGs in order to minimize daily power loss in case of uncertainty of wind and PV system. Three different types of DGs, photovoltaic DG (PVDG), wind DG (WDG) and conventional DG (CDG) are connected to IEEE 33-bus system. Monte Carlo simulation (MCS) is used to generate probable scenarios for wind and photovoltaic power plants based on actual data for wind speed and solar radiation for one day. Fast forward scenario reduction (FFSR) is used to reduce the number of scenarios generated by MCS. Particle swarm optimization (PSO) is used to minimize daily power losses through determining the optimum operating point (operating power and power factor (PF)) for CDG to cope with PVDG and WDG uncertainties.

Abstract Obesity upsurges the risk of developing cardiovascular disease, primarily heart failure and coronary heart disease. Chia seeds have a high concentration of dietary fiber and increased concentrations of anti-inflammatoryand antioxidant compounds. They are used for weight loss plus enhancing blood glucose and lipid profile. The current perspective was commenced to examine the protective influence of chia seeds ingestion on cardiovascular disease risk factors in high-fat diet-fed rats. Forty male albino rats (with an initial body weight of 180–200 g) were used in this study. Rats were randomly and equally divided into 4 groups: Group I was the control group and group II was a control group with chia seeds supplementation. Group III was a high-fat diet group (HFD) that received HFD for 10 weeks and group IV was fed on HFD plus chia seeds for 10 weeks. In all groups Echocardiographic measurements were performed, initial and final BMI, serum glucose, AC/TC ratio, lipid profile, insulin (with a computed HOMA-IR), creatinine phosphokinase-muscle/brain (CPK-MB), CRP, and cardiac troponin I (cTnI) and MAP were estimated. Whole heart weight (WHW) was calculated, and then WHW/body weight (BW) ratio was estimated. Eventually, a histopathological picture of cardiac tissues was performed to assess the changes in the structure of the heart under Haematoxylin and Eosin and Crossmon’s trichrome stain. Ingestion of a high diet for 10 weeks induced a clear elevation in BMI, AC/ TC, insulin resistance, hyperlipidemia, CRP, CPK-MB, and cTnI in all HFD groups. Moreover, there was a significant increase in MAP, left ventricular end diastolic diameter (LVEDD), and left ventricular end systolic diameter (LVESD). Furthermore, histological cardiac examination showed structural alteration of the normal structure of the heart tissue with an increase in collagen deposition. Also, the Bcl-2 expression in the heart muscle was significantly lower, but Bax expression was significantly higher. Chia seeds ingestion combined with HFD noticeably ameliorated the previously-recorded biochemical biomarkers, hemodynamic and echocardiography measures, and histopathological changes. Outcomes of this report reveal that obesity is a hazard factor for cardiovascular disease and chia seeds could be a good candidate for cardiovascular system protection.

Abstract Background We recently adapted a guideline for Community-Acquired Pneumonia (CAP) in children to the Egyptian health system. Adaptation of evidence-based clinical practice guidelines to the local healthcare context is a valid alternative to de novo development that can upgrade their application without enforcing a major burden on resources. The objective of this manuscript is to elucidate diagnosis, treatment, and prevention of CAP as well as methods used for the adaptation process to produce the 1st National Guideline for Community-Acquired Pneumonia in children in Egypt using Adapted ADAPTE method. The full process was described extensively with all three phases of set up, adaptation, and finalization. An adaptation group and an external review including clinical content experts and methodologists conducted the process. Results The authors adapted 10 principal categories of recommendations from three source Clinical Practice Guidelines. Recommendations incorporate; common clinical manifestations, indications for hospitalization and intensive care unit admission, indications for laboratory investigations and radiology in diagnosis, choice of empiric antibiotic therapy in the outpatient and hospitalized children with non-complicated CAP and the duration of therapy, the role of influenza antiviral therapy, follow-up anticipated response to therapy, management of non-responding pneumonia, criteria of safe discharge, and prevention of CAP. Many tools were gathered and established to improve implement ability containing two clinical algorithms for management of non-complicated CAP and for non-responding pneumonia in children, pathway for assessment of severity of CAP in primary care facilities, medication tables, simplified Arabic patient information, PowerPoint slide presentation lecture for management of CAP, and online resources. Conclusion The final clinical guideline supports pediatricians and related healthcare workers with evidence-based applicable guidance for managing community-acquired pneumonia in Egypt. This work demonstrated the efficiency of Adapted ADAPTE and highlighted the importance of a cooperative clinical and methodological professional group for adaptation of national guidelines.

Abstract Background COVID-19 leads to severe overwhelming inflammation in some patients mediated by various cytokines (cytokine storm) that usually leads to severe illness accompanied by cardiovascular manifestations. Growth differentiation factor-15 is a cytokine induced by stress and is associated with inflammatory processes in the lung and heart. This study aimed to measure the level of serum growth differentiation factor (GDF-15) in children with COVID-19 and to correlate it with the disease severity, cardiac affection, and the outcome of COVID-19. Methods A cross-sectional study was conducted on 144 children; 72 children diagnosed with COVID-19, and 72 healthy children. The severity of COVID-19 was assessed clinically, laboratory, and radiologically. Echocardiography was done within 48 h of admission for COVID-19 patients. Serum GDF-15 was measured by ELISA for both patients and controls. Results Serum GDF-15 level was significantly higher in patients with COVID-19 than in controls (p

Abstract Aims/Introduction Peripheral artery disease (PAD) serves as a risk factor for diabetic foot ulcers (DFUs). PAD pathology involves atherosclerosis and impaired immunity. Non‐classical monocytes are believed to have an anti‐inflammatory role. 1,25‐Dihydroxy vitamin D (vitamin D3) is claimed to have immune‐modulating and lipid‐regulating roles. Vitamin D receptor is expressed on monocytes. We aimed to investigate if circulating non‐classical monocytes and vitamin D3 were implicated in DFUs associated with PAD. Materials and Methods There were two groups of DFU patients: group 1 (n = 40) included patients with first‐degree DFUs not associated with PAD, and group 2 (n = 50) included patients with DFU with PAD. The monocyte phenotypes were detected using flow cytometry. Vitamin D3 was assessed by enzyme‐linked immunosorbent assay. Results DFU patients with PAD showed a significant reduction in the frequency of non‐classical monocytes and vitamin D3 levels, when compared with DFU patients without PAD. The percentage of non‐classical monocytes positively correlated with vitamin D3 level (r = 0.4, P

BackgroundThe early detection of breast cancer (BC) is receiving global attention, creating an urgent need for more sensitive and comprehensive strategies for preventive intervention, therapy assessment, and prognosis prediction. Aberrant expression of miRNAs has been observed in various malignancies and may be potential targets for therapy. Our study aims to examine the expression profiles of miR-375, miR-574-3p, and miR-122 in the sera of Egyptian women with BC, benign breast lesions, and a control group. We hope to determine if these miRNAs can serve as minimally invasive biomarkers for BC.MethodsThis is a case-control study in which 77 patients with newly diagnosed BC, 20 patients with benign breast tumors, and 30 normal healthy subjects as controls were recruited from the outpatient clinic of the National Cancer Institute. The assessment of miRNAs was conducted using RT-PCR (Applied Biosystems).ResultsThe expression level of miRNA-122 was significantly upregulated in the BC group, while the expression levels of miRNA-574 and miRNA-375 showed significant downregulation in BC patients. Serum miR-122 and miRNA-375 were able to distinguish breast cancer from the benign and control groups in ROC curve analysis, with AUCs of 0.786 and 0.796, respectively. Our results also showed that serum miR-122 and miR-574 are significant predictor variables in the multivariate analysis, after adjusting for age.ConclusionsOur findings suggest that miR-122 may act as an onco-microRNA, while miR-574 and miR-375 may have a main tumour suppressor role. The studied miRNAs may serve as minimally invasive biomarkers for cases of breast cancer and as promising potential therapeutic targets for breast cancer.

Cyberbullying has emerged as a pervasive problem among high school students, with potentially severe consequences for their mental well-being. This study aimed to investigate the prevalence, risk factors, and associations of cyberbullying with stress and mental well-being among high school students in Zagazig, Egypt. A cross-sectional study was conducted among 562 high school students using a random sampling technique. The data were collected using a self-administered questionnaire that included the Cyberbullying Scale, Perceived Stress Scale (PSS-10), and General Health Questionnaire (GHQ-12). Descriptive statistics, independent samples t-tests, multiple regression, mediation, and logistic regression analyses were employed for data analysis. The prevalence of cyberbullying victimization was 38.3%, with 20.6% exposed to two or three cyberbullying behaviors and 4.1% exposed to four or more. Female students, those under 18 years old, those with lower educational achievement, and those with higher daily internet use were more likely to experience cyberbullying. Cyberbullied students reported significantly higher levels of perceived stress and poorer mental well-being compared to non-cyberbullied students. Perceived stress likely mediated the relationship between cyberbullying victimization and general psychological health. Cyberbullying is a significant problem among high school students in Zagazig, Egypt, with detrimental effects on their stress levels and mental well-being. Targeted interventions and prevention strategies are needed to address cyberbullying and promote the well-being of adolescents in the digital age.

Background: Bronchial asthma increasing all over the world and the need of a gold-standard biomarkers for prediction of asthma and follow up of treatment is mandatory. However, it is still not existing.Aim of the work: To measure the serum level of plasma myeloperoxidase [MPO], and its correlation with respiratory function as well as its predictive power of asthma and its severity.Patients and Methods: The study recruited 130 patients with asthma, with age and sex-matched other 130 healthy controls. Patients were clinically evaluated; respiratory functions were performed and blood samples were drawn to estimate the serum levels of MPO. In addition, sputum was assessed for cellular content. Asthma severity was determined according to available guidelines and both mild and moderate forms were considered as [non-severe form of asthma]. Receiver operation characteristic [ROC] curve was built to assess the predictive power of MPO.Results: There was female-sex predominance in the study and control groups [65.4% and 70.0%, respectively]. 15.4% had mild, 35.4% had moderate and 49.2% had severe asthma. MPO levels were significantly higher in the study than the control groups [3310.35±373.39 vs. 1900.32±333.57 pg/ml, respectively]. The serum levels of MPO were positively correlated with asthma severity, all cellular content in BAL and body mass index. However, it was inversely correlated with respiratory function. MPO were significantly higher in severe than non-severe forms [3666.59±736.37 vs. 2964.91±554.47 pg/ml, respectively]. MPO had a good predictive power of asthma and its severe form [the AUC was 0.950 and 0.819 respectively].Conclusion: Serum levels of MPO can used as a good biomarker for diagnosis of asthma and its severity. But results must be treated with caution, and MPO should be used with a panel of biomarkers till more evidence originated to confirm its role from future studies.

طريقة التأريخ الخاصة بنابليون بونابرت على نقد ذهب لسليم الثالث [AR] يعتبر نابليون بونابرت أحد أشهر الشخصيات التاريخية العالمية، والذي غزا مصر بحملتة الفرنسية في فترة حكم السلطان العثماني الثامن والعشرين السلطان سليم بن مصطفى. وعلى الرغم من قصر مدة الحملة الفرنسية التي كانت قرابة ثلاث سنوات فقط، إلا أنها شكّلت نقطة تحول في تاريخ مصر حتى بعد انسحابها ، خاصة وأنها كانت تمثل أول غزو أوروبي على مجتمع اسلامي متمسك بقيمه وعاداته. أما فيما يخص السياسة النقدية التي كانت متبعه في مصر وقت مجيء الحملة الفرنسية، فهي نفسها التي عرفت في مقر السلطنة العثمانية باعتبار مصر ولاية تابعة لها، وبالتالي كان الزر محبوب النقد الذهبي الرئيسي للدولة. وتأتي أهمية النقد الذهبي قيد الدراسة من كونه مصنف على أنه عملة نادرة ضربت في فترة وجود بونابرت في مصر، خاصة وانه قد تم ضربها في العام الأخير من الحملة الفرنسية. ومن خلال دراسة طريقة التأريخ التي سجلت على هذه القطعة من منظور جديد ، فقد عكست ما كان يعرف عن نابليون بونابرت لموهبته في الدهاء السياسي ، وشخصيته الجاذبة ، وعقليته الحكيمة. فقد تبنى نابليون بونابرت سياسة الاقتراب من الشعب لتلبية أغراضة الخاصة، خاصة وانه كان يدرك مدى أهمية الرأي العام. هذه الأغراض في مصر كانت اقتصادية في المقام الأول، وليست السيطرة السياسية. كان هذا واضحًا من خلال الاتجاه الذي اتبعه في سك العملات المعدنية، بينما كانت مصر تحت سلطته. لذلك ساعدت الدراسة التحليلية للعملة في تأكيد نواياه الحقيقية ، وعكس وتأكيد سمات شخصيته الرئيسية. [EN] One of the world's most famous historical figures was Napoleon Bonaparte, who conquered Egypt with his French expedition in the reign of the twenty-eighth Ottoman Sultan Selim B. Mustafa, known as Selim Ш. Despite the short presence of the French expedition, approximately three years only, it marked a turning point in Egypt’s history even after its withdrawal. It was considered the first modern European conquest into the heartlands of the Islamic World, on an Islamic community that adhered to Islamic customs and values. Regarding the monetary system of Egypt at the time, Egypt abided by the trend of the Ottoman Empire in minting gold coins, as it was notable that there was a unified prototype for all Ottoman coins minted in the different Ottoman countries. Therefore, the main gold coin by this time was the Zeri Mahbub. The specimen investigated in this study is classified as a rare coin minted by Bonaparte, as it was minted in the last year of the French expedition. Studying its dating method from a new perspective reflected what was known about Napoleon Bonaparte regarding his political savvy, charisma, and smart thinking. Napoleon adopted a policy of getting closer to the people to achieve his main goals, which were primarily economic rather than aiming at political control. His manner was evident in the trend he followed in minting coins while ruling Egypt. Therefore, the analytical study of the coin helped demonstrate his real ideological intentions and reflect his primary personality traits.

Abstract Background Lead (Pb) and cadmium (Cd) heavy metals are considered potentially hazardous toxins which cause serious health problems. Many studies reported that the water of Qaroun Lake in Fayoum, Egypt with its fish farms was contaminated with Pb and Cd above permissible levels. However, there is a lack of studies addressing levels of these toxic metals among inhabitants. Objectives We aimed to evaluate blood levels of Pb and Cd and their potential health risk among inhabitants around Qaroun Lake. Materials and methods This case-control study estimated Pb and Cd blood levels among 190 individuals from two destinations (near and far away) of Qaroun Lack using an atomic absorption spectrometer after full history taking and routine checkup investigations; Full blood count, serum ferritin, liver enzyme (ALT), and creatinine levels. Results There was a significant difference between blood levels of Pb and Cd heavy metals of inhabitants from near and far away Qaroun Lake destinations (p-value 0.05). The difference between studied populations regarding types of anemia was not statistically significant. Subclinical leucopenia was higher in the population near Qaroun Lake when compare to inhabitants far from the lake (13.6% vs. 4.8%, p-value 0.032). Conclusion Bio-monitoring of populations exposed to Pb and Cd hazardous substances could help in generating an early warning system to reduce the disease burden associated with their toxicity.

Background: Pregnancy in the setting of type 1 diabetes (T1D) is associated with increased morbidity and mortality. There is strong evidence to suggest that the use of continuous glucose monitoring (CGM) is associated with better glycemic control and reduced adverse pregnancy outcomes. As hybrid closed-loop (HCL) systems are increasingly used among women with T1D, many prefer to continue off-label use of these systems during pregnancy. However, most of the available HCL systems’ glucose targets and algorithms are not designed to overcome the challenges that face insulin therapy during pregnancy. We are reporting on two females with T1D who used MiniMed 780G, an advanced HCL system, during their pregnancy with good outcomes. Cases presentation: Case 1: A 23-year-old woman with T1D presented at 6 weeks gestation. She used MiniMed 780G before pregnancy and throughout her pregnancy. By assisting her HCL system with some techniques, such as earlier bolusing before meals and the use of fake carbs to correct high glucose, and providing frequent follow-up, she achieved pregnancy-specific HbA1C and CGM glycemic targets and had good perinatal outcomes. Case 2: A 26-year-old female with T1D presented at 10 weeks gestation. She had been using MiniMed 670G since before pregnancy, thereafter, she was shifted to MiniMed 780G at 23 weeks gestation. We offered her the same techniques to support her HCL, and she achieved pregnancy-specific time in range (psTIR) in the 3rd trimester with good perinatal outcomes. Conclusion: We could achieve most of the pregnancy-specific glycemic targets with good maternal, fetal, and neonatal outcomes using MiniMed 780G, assisted with some techniques to increase the efficiency of insulin therapy during pregnancy.

1)Background: Kidney stones is one of the serious medical conditions affecting populations worldwide. So, we aimed in this study to investigate the protective effect of allium cepa administration against KSD. 2)Methods: 24 adult male albino rats were assigned into 3 groups; group I: control group; group II: received ethylene glycol (EG) in the drinking water for 4 weeks; and group III received EG in the drinking water plus freshly prepared allium cepa extract (ACE) for 4 weeks. Renal function tests and urine analysis were done. Tissue oxidative stress markers (SOD and MDA) were assessed, and kidney expression of SIRT-1, Beclin, LC3, osteopontin, and Regucalcin were measured by RT-qPCR. Histopathological assessment and immunohistochemistry for Bax, Beclin-1 and TNF-α were performed. 3)Results: There was a significant improved kidney function tests in the ACE received group compared to EG group (P

Highlights ● NAFLD is deliberated a complicated health problem owing to its growing prevalence, complex pathogenesis, and difficulty to diagnose. ● It is crucial to find an efficient noninvasive and affordable biomarker for earlier identification and staging of NAFLD. ● Ultimate role of miRNA-34a in lipid metabolism dysregulation may lead to NAFLD. ● MiRNA-34a and MiRNA-192 are broadly stated to play a role in the development of NAFLD and NASH.

Abstract Background All pediatric health organizations are concerned about the impact of coronavirus disease on children, especially on those with other comorbidities; fortunately, pediatric cases appear to be less severe than in adults (De Luca et al. in Pediatr Respir Rev 5:9–14, 2020). The purpose of this study is to characterize chest CT findings of children with and without comorbidities who had confirmed coronavirus disease (COVID-19) and to investigate the relation between chest CT findings and the clinical severity of COVID-19 pneumonia and their laboratory findings. Results The study was conducted on 36 patients, 72.2% of whom had associated comorbidities. Twenty-three patients (63.88%) had abnormal CT findings. Consolidative patches were the most common radiological sign (55.6%) followed by ground glass opacities (50%). The lesions were bilateral (58.3%), having predominantly peripheral distribution (38.9%) with predominant left lower lobe affection (25%). Cases with clinically severe chest conditions had significantly more prevalent consolidative patches (p = 0.026) which show a higher CT density (p = 0.01) and a significantly higher CT severity score (SS) compared to other groups (p = 0.029). The cutoff of severity score 4/20 had 100% sensitivity and 78.12% specificity in the diagnosis of severe cases. There were no statistically significant differences between patients with or without comorbidities regarding CT-SS or any radiological signs. Conclusions Consolidation was the most common radiological finding in children with COVID-19 and was more prevalent and denser in severe cases. The CT-SS may be used as a complementary tool for the evaluation of the severity of the chest condition. Chest CT-SS more than 4 can be used as an indicator of severe cases, yet no significant difference in CT-SS between patients with associated comorbidities or not.

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was $216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with $195 for low FiO2 leading to a −$11 (95% CI: −$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was $1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this.

Artificial intelligence (AI), often known as machine learning, is a powerful tool for solving engineering problems. The evaluation of the network reliability of a flow network is a NP-hard problem, with computational effort growing exponentially with the number of nodes and arcs in the network. Also, the components assignment issue is NP-hard, and the computational effort increases with the number of available components. Many candidate solutions are typically examined during optimal components or optimal capacity assignment, each requiring reliability calculation. Consequently, this paper proposes an artificial neural network (ANN) predictive model to evaluate the flow network reliability. The neural network is one of the artificial intelligence tools constructed, trained, and validated using the maximum capacity of each component input and the network reliability as the target. The proposed ANN model provides empirical proof that neural networks can accurately estimate reliability by modeling the connection between the maximum capacities of network components and the reliability value.

Abstract Introduction Older adults with Alzheimer’s disease (AD) experience drastic changes in their physical and mental abilities. AD patients became heavily dependent on their caregivers for everyday functions, which have significant implications not only for them but also for their caregivers. So, many AD caregivers experienced an increased level of depression and anxiety symptoms, lower perceived control, and higher burden compared to non-AD caregivers. Therefore, psychological first aid (PFA) and educational interventions are designed to enable those caregivers to meet the daily requirements of their patient care and to cope with its challenges. Aim Determine the effect of psychological first aid program on stress level and psychological well-being among caregivers of older adults with Alzheimer’s disease. Design One group pre-test post-test was followed. Subjects A convenience sample of one hundred (100) caregivers of older adults with AD. Setting All online groups concerned with the care of Alzheimer’s disease patients on Facebook. Tools Socio-demographic and clinical data of older adults with Alzheimer’s disease and their caregivers’ questionnaire, Alzheimer’s disease knowledge scale, Kingston caregiver stress scale, and authentic identity measures (AIM) scale of psychological well-being Results The psychological first aid program has highly statistically significant effect on the AD caregivers’ knowledge, stress level and psychological well-being as (t=-30.707, P = 0.000, t = 8.500, P = 0.000 & t= -4.763, P = 0.000 respectively). Conclusion Psychological first aid program is considered an effective intervention in decreasing the AD caregivers’ stress and increasing their psychological wellbeing and knowledge regarding delivering care for AD patients.

Background: Tricuspid valve disease is most commonly functional, however, organic affection still accounts for one fourth of cases. Rheumatic fever which is endemic in Egypt is a main cause of organic affection. Current practice largely relies on tricuspid valve repair; however, it has been difficult to determine optimal procedure. Objectives: Herein, we study the outcome of replacement versus repair in such patients. Patients and methods: A prospective study was conducted on 300 consecutive patients with rheumatic heart disease showing severe tricuspid valve affection underwent tricuspid valve surgery, between 2014 and 2018. The patients were divided into two groups; TVR group (n=150) which included patients who underwent tricuspid valve replacement and TVr group (n=150) which included patients who underwent tricuspid valve repair. Diagnosis and follow up were done by echocardiography. Peri-operative variables, clinical outcome, morbidity, mortality, and follow up data were recorded. Results: Mean follow-up was 4±1.32 years. In-hospital mortality was 6 patients (4%) in TVR group and 3 patients (2%) in TVr group (P value ≥ 0.05). Postoperative low cardiac output syndrome and stroke were significantly higher in the repair group. Postoperative RV dysfunction, renal impairment, renal failure and chest re-exploration were significantly higher in the replacement group. Severe tricuspid regurgitation was reported in 19 patients (12.6%) of the repair group on follow up. Conclusion: Tricuspid valve repair is preferable to replacement to avoid the drawbacks of prosthesis. However, tricuspid valve replacement is feasible with comparable survival outcome and the progressive nature of the rheumatic disease may recommend replacement.

Abstract Background Diarrhoea is still a major public health issue in developing countries, and it is one of the leading causes of morbidity and mortality in children. We aimed to assess the use of a multiplex reverse transcription polymerase chain reaction (RT-PCR) assay for the detection of five viruses, including rotavirus, norovirus (genogroups 1 and 2), astrovirus, and adenovirus, responsible for gastroenteritis in children under 5 years old in primary care centres in Upper Egypt. Subjects and methods A total of 500 stool samples were collected. Fifty samples were randomly selected for viral examination using multiplex RT-PCR for the detection of rotavirus, norovirus (genogroups 1 and 2), astrovirus, and adenovirus, causing diarrhoea. Results Viruses were detected in 45 (90%) of the 50 stool samples. The most frequently identified virus was norovirus G2, followed by Group A rotavirus, astrovirus and adenovirus. Mixed infection by two and three viruses was observed in 7/50 cases (14%) and 2/50 cases (4%), respectively. Norovirus G1 was not detected in the samples examined. Conclusion Our study reveals that multiplex PCR allows for the detection of multiple viral targets in only one reaction, rendering the assay easier to perform compared to existing testing methodologies (RT-PCR and electron microscopy). Additionally, most of the viruses were detected in summer, and the highest prevalence was in the age group less than 1 year. Norovirus G2 and rotavirus were the most frequent agents and the most common coinfections responsible for gastroenteritis in children.

Abstract Background The presented evidence-based clinical practice guideline (CPG) is proposed as a National CPG using an evidence-based and formal CPG adaptation methodology. The purpose of this study was to adapt the international CPGs’ recommendations for children with bronchiolitis to suit the healthcare system in the Egyptian context. This CPG, ‘diagnosis, treatment, and prevention of Bronchiolitis’, applies to children from 1 through 23 months of age. Other exclusions are noted. The quality of evidence, benefit-harm relationship, and strength of recommendations are indicated. This study is part of a larger collaborative initiative with the faculty staff of pediatric departments of 15 Egyptian universities and a national research center to formulate a national Committee (EPG) that aims to define the topics of, assign authors to, and assist in the adaptation of pediatric evidence-based CPGs according to a national strategic plan. The committee is guided by a formal CPG adaptation methodology: the ‘Adapted ADAPTE’. Results The Bronchiolitis Guideline Adaptation Group (BGAG) reviewed the results of the AGREE II assessment and decided to adapt mainly the Australasian (PREDICT) CPG and for the questions not answered in PREDICT we adapted the relevant recommendations from the American Academy of Pediatrics (AAP) CPG. Seven implementation tools were included: a care pathway for assessment of severity, a clinical algorithm for treatment of acute bronchiolitis in the emergency room, a separate flowchart for assessing babies with bronchiolitis, a power point slide presentation lecture for treatment of acute bronchiolitis, patient information in Arabic, a clinical score (Modified Tal Score) for prediction of bronchiolitis severity, and the criteria for admission and discharge in the hospital. A comprehensive set of multifaceted CPG implementation strategies was provided for the clinicians, patients, nurses, and other relevant stakeholders contextualized to the national settings Conclusion Our experience with this adaptation methodology provides useful insight into its utilization on a national level in Egypt. The BGAG recommended the next review of this adapted CPG to be after 3 years from its publication (i.e., 2022) after checking for updates in the original CPG.

Background: In limited resource settings, compliance to proper personal protective equipment (PPE) use is challenging. This study aims to characterize the pattern of PPE use among healthcare workers (HCWs) during the first wave of coronavirus diseases-2019 (COVID-19) in Egypt and to determine the factors associated with compliance to the proper use of PPE. Methods: A cross-sectional study was conducted among Egyptian HCWs using an online self-administered questionnaire. Participants were classified as “Compliant” or “Non-compliant” according to their score. Results: A total of 404 responses were analyzed, with a mean age of 36.6 ± 8.4 years, and 56.4% were females. Non-compliant HCWs represented 53.2% of participants. The majority reported shortage in N95 respirators (91.3%) and practiced extended PPE use (88.1%). Better compliance to proper PPE use was reported: females (51.3%, p = 0.05), Physicians (54.2 %, p = 0.005), medical specialities (34.7 %, p < 0.001), eight hours/day (71.3%, p < 0.001). The significant predictors for compliance were; receiving prior training on the proper use of PPE (OR: 4.59, CI: 2.22–9.47, p ≤ 0.001), exposure to COVID-19 patients (OR: 2.75, CI: 1.19–6.35, p = 0.02) and performing procedures that pose HCWs at a high risk of exposure to Severe Acute Respiratory Syndrome Coronavirus 2 (OR: 2.21, CI: 1.04–4.71, p = 0.04). The high percentage of non-compliant HCWs turns on a warning signal. Increase the availability of PPE, prioritize their use, provide more focus on training of HCWs and monitor their compliance is highly recommended.

Abstract Background New onset seizure (NOS) is defined as the first seizure within a 24-h period ever experienced by the patient. Cluster seizures (CS) or status epilepticus (SE) can be the first manifestation of epilepsy or it may be a symptom of a brain tumor, a systemic disorder, an infection, or a syndrome. This study aims to determine the etiology of CS and SE in NOS among adult Egyptians. One hundred twenty adult Egyptian patients presented with NOS were enrolled in a hospital-based cross-sectional observational study within a time period of 6 months from March till September 2018. All patients were subjected to neurological examination including mini mental status examination, laboratory, neuroimaging, and electroencephalogram. Results Among 120 adult patients presented with NOS, males were prevalent (63%). Older adults (> 55 years) were prevalent (60%). Of the patients, 25% presented by CS, while 11% presented by SE. Post-stroke epilepsy (41%) was the predominant etiology of NOS. Cerebrovascular diseases (CVDs) were the prevalent etiology of SE in NOS (35%). NOS presented by CS were more prevalent among patients with brain tumors (29%) in comparison to CVDs (25%). Conclusion CS represented 25% of NOS in adult Egyptian patients. SE is prevalent among 11% of NOS. Despite CVDs being the most prevalent etiology of NOS in adult population (41%) including those presented with SE (35%), brain tumors are the most prevalent etiology of new onset CS (29%).

Abstract Background New-onset seizure (NOS) is defined as the first seizure within a 24-h period ever experienced by the patient. A first-ever seizure can be the first manifestation of epilepsy. Or it may be a symptom of a brain tumor, a systemic disorder, an infection, or a syndrome that deserves special attention and treatment. This study aims to identify the etiology of NOS among different age and sex groups of adult Egyptian patients. A hundred and twenty adult Egyptian patients (> 18 years) presented with acute NOS were enrolled in a hospital-based cross-sectional observational study from the emergency room and neurology outpatient clinics of our hospitals within a time period of 6 months from March till September 2018. All patients were subjected to neurological examination, laboratory, neuroimaging, and electroencephalogram investigations. Results Among 120 adult patients presented with NOS, males were prevalent (63%). Older adults (age group > 55 years) were the most prevalent cohort (60%). Cerebrovascular diseases (CVDs) were the most common identified etiology of NOS (44.17%), followed by idiopathic epilepsy syndrome (18.33%), symptomatic mainly “metabolic” (11%), brain tumors (9.17%), post-traumatic epilepsy (6.67 %), encephalitis (5.83%), and cryptogenic (5%). Idiopathic epilepsy syndrome was the most common etiology (55.56%) of new-onset seizures among the young adult age group ( 55 years). Also, CVDs were the most common etiology among males (43.4%) as well as females (45.4%). However, male predominance was the highest among post-traumatic seizures (87.5%). And female predominance was the highest among brain tumors identified etiology of NOS (54.5%). Conclusion NOS among adults are prevalent in elder males. CVDs are the most commonly identified etiology of adult NOS across males and females. Idiopathic epilepsy syndromes are the predominant etiology among younger adults.

The study aimed to assess the accuracy of two-dimensional speckle tracking echocardiography (2DSTE) to evaluate the left atrial (LA) function in patients with heart failure. And can it differentiate accurately between heart failure preserved ejection fraction (HFpEF, HF with mid-range ejection fraction (HFmrEF=EF 41-49%) and heart failure with reduced ejection fraction (HFrEF= EF50%), 56 patients with HFmrEF (LVEF 41-49%), 56 patients with HFrEF (LVEF

Purpose – This paper aims to obtain accurate forecasts of the hourly residential natural gas consumption, in Egypt, taken into consideration the volatile multiple seasonal nature of the gas series. This matter helps in both minimizing the cost of energy and maintaining the reliability of the Egyptian power system as well. Design/methodology/approach – Double seasonal autoregressive integrated moving average-generalized autoregressive conditional heteroskedasticity model is used to obtain accurate forecasts of the hourly Egyptian gas consumption series. This model captures both daily and weekly seasonal patterns apparent in the series as well as the volatility of the series. Findings – Using the mean absolute percentage error to check the forecasting accuracy of the model, it is proved that the produced outcomes are accurate. Therefore, the proposed model could be recommended for forecasting the Egyptian natural gas consumption. Originality/value – The contribution of this research lies in the ingenuity of using time series models that accommodate both daily and weekly seasonal patterns, which have not been taken into consideration before, in addition to the series volatility to forecast hourly consumption of natural gas in Egypt.

Abstract Background Recovery of upper extremity (UE) motor function after stroke is variable from one to another due to heterogeneity of stroke pathology. Structural and biochemical magnetic resonance imaging of the primary motor cortex (M1) have been used to document reorganization of neural activity after stroke. Objective To assess cortical biochemical and structural causes of delayed recovery of UE motor function impairment in chronic subcortical ischemic stroke patients. Methodology A cross-sectional study with fifty patients were enrolled: thirty patients with chronic (> 6 months) subcortical ischemic stroke suffering from persistent UE motor function impairment (not improved group) and twenty patients with chronic subcortical ischemic stroke and improved UE motor function (improved group). We recruited a group of (16) age-matched healthy subjects. Single voxel proton magnetic resonance spectroscopy (1H-MRS) was performed to measure n-acetylaspartate (NAA) and glutamate+glutamine (Glx) ratios relative to creatine (Cr) in the precentral gyrus which represent M1of hand area in both ipsilesional and contralesional hemispheres. Brain magnetic resonance imaging (MRI) to measure precentral gyral thickness is representing the M1of hand area. UE motor function assessment is using the Fugl Meyer Assessment (FMA-UE) Scale. Results The current study found that ipslesional cortical thickness was significantly lower than contralesional cortical thickness among all stroke patients. Our study found that ipsilesional NAA/Cr ratio was lower than contralesional NAA/Cr among stroke patients. UE and hand motor function by FMA-UE showed highly statistically significant correlation with ipsilesional cortical thickness and ipsilesional NAA/Cr ratio, more powerful with NAA/Cr ratio. Conclusion We concluded that persistent motor impairment in individuals with chronic subcortical stroke may be at least in part related to ipsilesional structural and biochemical changes in motor areas remote from infarction in form of decreased cortical thickness and NAA/Cr ratio which had the strongest relationship with that impairment.

Abstract Background Atherosclerotic intracranial arterial stenosis (ICAS) is one of the most common causes of stroke worldwide and is associated with a high risk of recurrent stroke. Patients with a recent transient ischemic attack (TIA) or stroke and severe stenosis (70 to 99% of the diameter of a major intracranial artery) are at particularly high risk for recurrent stroke in the territory of the stenotic artery (approximately 23% at 1 year) despite medical treatment. Therefore, alternative therapies are urgently needed for these patients. Objective To determine the efficacy and safety of angioplasty with stenting in medically refractory ICAS and to compare its effectiveness with optimal medical treatment. Subjects and methods Fifty patients with symptomatic ICAS despite medical treatment (i.e, recurrent stroke or TIA) were enrolled and equally randomized in a prospective study where twenty-five patients underwent angioplasty with stenting and twenty-five patients received optimal medical treatment. Clinical assessment with NIHSS and mRS were done at 0, 3, and 6 months, and transracial Doppler (TCD) assessment of ICAS was done at 0 and 3 months after treatment. Results The interventional group had a better clinical outcome with mean NIHSS scores (5.2 ± 4.2, 4.43 ± 4.28 and 3.9 ± 4.7) at baseline, 3 and 6 months, respectively, in comparison to the medical group with mean NIHSS (4.5 ± 4.2, 11.42 ± 6.3, and 8.5 ± 5.1) and better functional outcome with mean mRS scores (1.3 ± 0.96, 1.2 ± 1.13, and 1.0 ± 1.13) at baseline, 3 and 6 months, respectively, in comparison to the medical group (0.84 ± 0.75, 2.28 ± 1.2, and 2 ± 1.24). TCD assessment of ICAS showed a marked reduction of the percentage of stenosis on 3 months of follow-up among the interventional groups (only 5.6% had > 70% stenosis) in comparison to the medical group (85.7% had > 70% stenosis). Recurrent ischemic events on 6 months of follow-up were 16% among interventional groups in comparison to 84% among medical groups. The mortality rate was 8% among interventional groups due to subarachnoid hemorrhages (SAH) related to procedure in comparison to 28% among medical groups secondary to ischemic events. The intraoperative success rate was 96% with the failure of stent deployment in 1 patient due to the tortuous anatomy of vessels. Early post interventional complication rate, i.e, SAH was 8%. Late post interventional restenosis and occlusion rates were 8% on 3 months of follow-up. Conclusion Endovascular stenting of medically refractory ICAS is more efficacious and effective with better clinical and functional outcomes than optimal medical treatment; however, its safety is still debatable. Trial registration Done at ClinicalTrials.gov . Trial ID (NCT Number) NCT04393025 .

Abstract The local entomopathogenic bacterium, Bacillus thuringiensis (Bt) was isolated and characterized from 16 soil samples collected from different governorates in Egypt. Among 56 bacterial colonies obtained, only 16 colonies were characterized by traits of Bacillus. All the 16 isolates were toxic to the neonates of the cotton leaf worm, Spodoptera littoralis (Boisd.) (Lepidoptera: Noctuidae). Damietta and El-Sharkyia bacterial isolates showed appreciable mortality rates (100 and 96.6%), respectively, which were higher than that caused by the standard isolates of Bt entomocidus (that produce Cry1 C toxin) for which they were selected for further characterization. Scanning electron microscope of Damietta bacterial isolate showed the presence of a bipyramidal crystal protein; consistent with the presence of Cry1 toxin class, however, El-Sharkyia bacterial isolate produced spherical-shaped crystals consistent of Cry2 toxin class. Electrophoretic patterns of different isolates and standards revealed different molecular weight bands, ranged from 195 to 8KDa. Damietta and El-Sharkyia bacterial isolates produced major protein bands with molecular weights of 130 KDa, which was also present in Bt entomocidus. Both isolates also shared protein bands with Bt entomocidus with molecular weights of 80, 70, 65, 51, and 22 KDa. The 16S rRNA sequences of both isolates were submitted to the NCBI Gene Bank database, with accession numbers of LC070660 for Damietta isolate and LC070661 for El-Sharkiya isolate. The existence of different Cry genes in the 2 isolates was studied by PCR, using general primers of 5 Cry genes. Cry1 gene was detected in both isolates; however, Cry 2 gene was detected only in Damietta isolate.

Abstract Background Mitral valve stenosis in adults especially due to rheumatic heart disease may be associated with a smaller than normal left ventricular cavity. Mitral valve replacement in such cases may lead to hemodynamic instability either during weaning from cardiopulmonary bypass or in the early postoperative period manifested by the need for inotropic support and even mortality due to low cardiac output syndrome. Patients and methods 184 patients with predominately severe stenotic mitral valves who underwent elective isolated mitral valve replacement in the period between January 2012 and January 2018 at our hospital were included in this study. Patients were divided into 2 matched groups; (small LV group) consisting of 86 cases and (normal or dilated LV group) consisting of 98 cases. Results There were no statistically significant differences in operative details among both groups apart from the need for inotropic support and intra-aortic balloon pump due to low cardiac output which were statistically significantly higher in (small LV group) than (normal or dilated LV group) with a p-values of 0.01 and 0.03 respectively. Within the ICU stay only the incidence of occurrence of heart failure was significantly higher in (small LV group) with a p-value of 0.008. No statistically significant difference could be elicited in the in-hospital mortality between both groups (p-value = 0.1). Conclusion Patients with mitral valve stenosis and small left ventricular cavity are in a higher need for inotropic and even mechanical support after mitral valve replacement as well as at a higher risk for the development of heart failure before hospital discharge than patients with mitral stenosis and normal-sized left ventricular cavity.

The present study is aimed at examining the effect of reflective thinking strategies on developing literary reading skills and metacognitive reading awareness of the EFL student teachers. The study adopted the quasi-experimental design. One experimental group of 40 major English students at the third-year Faculty of Education, Zagazig University in Egypt, participated in the study. The treatment conducted in fourteen sessions through teaching King Lear drama by Shakespeare. The utilized instruments included a literary reading test that was developed and used as a pre-post test and a metacognitive reading awareness scale, which was also designed by the researcher and approved by the jury members. Parametric statistical calculations have used for data analysis through the SPSS program. Results revealed that reflective thinking had a positive effect on developing literacy reading skills and metacognitive reading awareness of the EFL student teachers.

Olea europaea is an evergreen tree, native to the Mediterranean region and well known for its edible fruits and oil. Recently much focus has been made on the leaves of the trees due to their high antioxidant property in addition to other therapeutic value. The leaves that are considered by-products during olive oil production are now an essential commodity in the nutraceutical industry. Koroneiki (Olea europaea L. cv Koroneiki) is one of the well-known Greek olive cultivars as the queen of oil-producing olive trees. Our study focuses on studying this tree growing in Egypt in regards to its total flavonoids (TF) and phenolic content (PPh) as well as antioxidant activity in 2 seasons in a comparative presentation. The average PPh for Koroneiki leaf extract was found to be 116.81±0.97 and 152.98±0.11 mg/g dried extract for autumn and spring respectively while TF was found to be 48.32±0.5 and 82.68±0.71 mg/g respectively. In autumn the oleuropein content was found to be 12.65±0.06 mg/100 g dried extract, while in spring marked an increase in oleuropein content reaching 92.25±0.26 mg/100 g was observed. The % inhibition of the free radical for autumn extract was found to be 86.56 %±0.39, while 90.09%±1.18 for spring. The results indicated that spring is the season of choice for leaf collection.

Identifying phenols in ornamental trees may provide sources of natural compounds that have applications in the agricultural and pharmaceutical industries. In this study, we profiled phenolic acids in the bark of Quercus sp. using HPLC-DAD. Q. robur showed high ellagic acid (in Q. robur). Q. macrocarpa had high caffeic acid. All species showed antibacterial and antifungal activities. P. aeruginosa was the most sensitive species for bark extracts. The antifungal activities were high against A. flavus. The study revealed new natural sources of phenolic acids that have antimicrobial activities with agricultural and pharmaceutical applications.

Bone disease is frequently observed in chronic kidney disease (CKD) and increases a patient’s risk for fracture. Sclerostin is an osteocyte-derived negative regulator of bone formation. We aimed to assess serum sclerostin level as a bone marker in children with CKD on regular hemodialysis (HD) and detect the association between this and bone density status. This cross-sectional comparative study was conducted on 25 children with CKD on HD and 25 age- and sex-matched healthy children, as controls. Their ages ranged from 4 to 18 years. Serum sclerostin levels were measured and dual-energy X-ray absorptiometry scan was performed in the same line with the traditional bone markers. There was a significant increase in serum sclerostin level in patients (1.754 ± 1.31 ng/mL) compared to controls (0.290 ± 0.074 ng/mL) with P = 0.001. Nine patients (36%) had low bone mineral density (BMD) with z score under -2.0, eight of whom had low BMD in both the neck of femur and lumbar spines. There was a significant increase in serum sclerostin levels in the patient-group with low BMD (2.38 ± 0.85 ng/mL) compared with patients with normal BMD (1.4 ± 0.98 ng/mL) (P = 0.001). A significant positive correlation was found between serum sclerostin level and alkaline phosphtase, parathormone with negative correlation with serum calcium. Sclerostin was 100% specific and sensitive in predicting CKD-mineral and bone disorder. Elevated sclerostin levels were consistent with low BMD and appear to be an independent predictor of reduced BMD in children on regular HD.

A limited number of publications have identified risk factors for Corona Virus Disease 2019 (COVID-19) among Healthcare Providers (HCPs). We aimed to assess the clinical and epidemiological characteristics and the predicting factors related to COVID-19 among HCPs in Egypt. A comparative cross-sectional study was conducted among HCPs via an online questionnaire. Out of 440 responses, a total of 385 complete responses were analyzed. The responders' mean age was 37.5±9.4 years, 215 (55.8%) of the participants were males. They included 77 (20%) confirmed COVID-19 cases; most of them had mild (58.6%) or moderate symptoms (30%), and (9.1%) were asymptomatic. Almost all sustained infection while on duty (97.4%). The sources of infection were either infected patients (39%), colleagues (22.1%), household contacts (5.2%) or uncertain (33.8%). The sources were symptomatic in only 62.3% of cases. Asymptomatic or pre-symptomatic sources accounted for 37.7% of the cases. Exposure occurred during healthcare provision in 66.3% of the cases. The presence of co-morbidities (OR = 2.53, CI 1.47-4.38, P = 0.001), working more than 8 hours per day in isolation hospital (OR = 3.09, CI 1.02-9.35, P = 0.046), training on hand hygiene (OR = 2.31, CI 1.05-5.08, P = 0.038) and adherence to IPC measures (OR = 2.11, CI 1.16-3.81, P = 0.014) were the significant predictors of COVID-19. In conclusion, COVID-19 occurred in 20% of responders. Silent spread from asymptomatic or presymptomatic patients, and infected colleagues in hospital settings is an alarming sign. Proactive infection prevention and control measures are highly encouraged on both strategic and operational levels. Reconsideration of surveillance strategy and work-related regulations in healthcare settings are warranted.

Background: End stage renal disease (ESRD) is a common cause of morbidity and mortality among children. Interleukin 4 is a cytokine that might influence the progression of chronic kidney disease (CKD) to end stage renal disease. There are variable number of tandem repeats (VNTRs) in IL4 gene that could play major roles in genetic predisposition to some diseases. Aim of the study: The purpose of this study is to detect the association of allelic variant in intron 3 VNTR-IL4 gene with the end stage renal disease and if these variants could be considered as risk markers for this disease. Subjects and methods: The study was conducted on fifty-five children with CKD and fifty healthy children served as controls. All participants were genotyped for intron 3 VNTR by Polymerase Chain Reaction. Results: The frequency of intron 3 VNTR-IL4 P1P2 + P2P2 genotypes was significantly higher in ESRD-children than those with P1P1 genotype (88.7% vs. 15.4%, OR 43; 95% CI 13–134, P value

Objectives: Our aim in this study was to evaluate the efficiency of combined positron emission tomography and computed tomography (PET/CT), in the detection of the primary tumor origin in patients with cancer of unknown primary (CUP). Methods: PET/CT were performed for 52 patients with CUP. These patients presented with metastatic lesions that were proven pathologically, and no primary site was detected by previous investigations. Results: The number of patients with true positive primary tumor sites was 29 (55.8%), 4 patients with false positive results (7.7%), 9 patients with true negative results (17.3%) and 10 patients with false negative results (19.2%). The sensitivity was 74.4%, specificity was 69.2% and accuracy was 73.1%. Our positive predictive value in this study was 87.9% and our negative predictive value for this study was 47.4%. Conclusions: This study showed an advantage of PET/CT in the detection of the site of the primary tumor in patients diagnosed with CUP. Keywords: Carcinoma of unknown primary, Detection of unknown primary tumor, 2-(18F)-fluoro-2-deoxy-d-glucose, Combined computed tomography and positron emission tomography

.The art of textile hanging is considered one of the richest and most sophisticate . Arts in fine arts sector. As it is one of the oldest and most famous applied arts which has highly aethetic and artistic values because it helps in completing the interior architectural design and it an important mean in adding aethetic values to public bulding and houses besides it is used in covering wide areas of empty walls .By studying the human harvest in this field, it was found that textile hanging designs were always considered the reflection of its era and its culture and artistic fields . hangings donot differ in its aimes from wall graphic but it is more different and accurate compared to graphic as it needs skills in the implenentation stage . the presented study gives one entry to enrich the art of wall hangings by studing the beauty of human inner cells to enrich the aethetical and functional values of the textile hangings used in the interior walls of medical treatment institutions .In this research many designs for textile hangings were made and eight of them were produced using half-mechanicsl tuft technique and all of them were inspired from human inner cells.

Aim: The aim of this study was to provide adequate protection to ewes and their lambs against Foot and Mouth disease (FMD) and Rift Valley Fever (RVF). Materials and Methods: A combined inactivated oil vaccine was prepared successfully. Such vaccine was found to be free from foreign contaminants, safe and potent as determined by quality control tests such as challenge protection percentage for FMD and mice ED50 for RVF. Vaccination of pregnant ewes with the prepared combined vaccine and determination of the antibody level via serum neutralization test (SNT) and Enzyme Linked immune sorbent assay (ELISA) in the vaccinated pregnant ewes and their lambs. Results: Vaccination of pregnant ewes revealed that these ewes exhibited high levels of specific antibodies against the included vaccine antigens (Foot and Mouth disease virus type A Iran O5, O PanAsia and SAT2/EGY/2012 and RVFV-ZH501). FMD antibodies recorded their peaks by the 10th week while those of RVF recorded their peaks by the 12th week post vaccination then all antibodies began to decrease gradually to reach their lowest protective titers for FMD by the 32nd week post vaccination and those for RVF by the 34th week post vaccination. Potency test of the prepared combined vaccine expressed as protection percentage of vaccinated sheep against target virulent FMD virus serotypes reflected a protection percentage of 80% against type O and SAT2 and 100% against A while for RVF, the mice ED50 was found to be 0.009 indicating the potency of the prepared vaccine. The antibody titer in serum and colostrum of vaccinated pregnant ewes at day of parturition (10-12 week post vaccination) recorded a high titer against FMD serotype (O), serotype (A), serotype (SAT2) and against RVF. It was noticed that the colostrum antibody titers were slightly higher than those in the sera of vaccinated ewes at time of parturition. The newly born lambs from vaccinated ewes, exhibited good levels of maternal immunity against the included antigens through suckling their mother colostrum by the 24 hrs. post parturition. The newly born lambs recorded their highest level by 1 week of birth and lasted within a protective level up to 11-12 week of birth. Conclusion: Using of FMD/RVF combined vaccine provided a sufficient immune status for pregnant ewes as well as for their lambs. Vaccination of newly born lambs should be carried out by the 4th month of birth.

Background: We studied JAZF1, ABCC8, KCNJ11and Notch2 gene expression and vitamin D receptor (VDR) polymorphisms (Fok1 and Bsm1) in patients with type 2 diabetes mellitus (T2DM) and tried to find out their association with microvascular complications in these patients. Methods: The study was conducted on 180 patients (93 complicated and 87 noncomplicated) and 150 healthy subjects. Reverse-transcriptase polymerase chain reaction (RT-PCR) was used to assess gene expression and real-time PCR was used to detect VDR genotypes. Serum vitamin D was assessed using Elisa technique. Results: After adjustment for age, sex, body mass index and glycated hemoglobin, altered Notch2 gene expression was found between patients and controls and between complicated and noncomplicated cases ( p = 0.001 and 0.001, respectively) and ABCC8 gene expression showed significant difference between patients and controls only ( p = 0.003), while JAZF1and KCNJ11 expression showed no significant difference between the studied groups ( p = 0.3 and 0.4, respectively). Serum vitamin D level was decreased in patients compared with controls ( p = 0.001), while no difference was detected between complicated and noncomplicated cases ( p = 0.1). Our results revealed no significant difference in VDR Fok1 and Bsm1 genotype distributions ( p = 0.7 and 0.1, respectively) and allele frequencies ( p = 0.4 and 0.1, respectively) between patients and controls. Patients with complications showed increased frequencies of Fok1GG genotype and G allele, while patients without complications showed increased frequencies of AA, then AG Fok1 genotype and A allele ( p = 0.001 and 0.001, respectively). In addition, the frequencies of CC Bsm1 genotype and C allele were significantly higher among patients with complications, while frequencies of TT Bsm1 genotype and T allele were significantly higher among patients without complications ( p = 0.02 and 0.003, respectively). Conclusion: Altered expression of Notch2 and ABCC8 genes may play a role in the pathogenesis of T2DM. Altered expression of Notch2 and VDR polymorphisms may play a role in the development of microvascular complications in diabetic patients. These results may assist in early identification and management of diabetic complications.