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Methylxanthines are widely used to manage pulmonary disorders, particularly in developing countries. Methylxanthines are unsafe due to their narrow therapeutic index and associated morbidity and mortality. The current study aimed to investigate the role of glucose/potassium ratio as a substantially useful early predictor of life-threatening events (LTEs) in the form of cardiovascular and neurological complications among methylxanthine users. A retrospective cohort study was conducted using medical records of patients diagnosed with acute methylxanthine intoxications and presented to an Egyptian Poison Control Center for 2 years. A total of 366 patients were enrolled. Of them, 59 patients (16.1%) were complicated with LTEs. The most frequent serious arrhythmia was T wave inversion (45.6% of patients with LTEs). Laboratory investigations that could significantly predict LTEs were the random blood glucose and potassium levels, glucose/potassium ratio, pH, liver transaminases, HCO3 level, hemoglobin, and platelet count (P

BackgroundAcute intoxication with central nervous system (CNS) xenobiotics is an increasing global problem. Predicting the prognosis of acute toxic exposure among patients can significantly alter the morbidity and mortality. The present study outlined the early risk predictors among patients diagnosed with acute exposure to CNS xenobiotics and endorsed bedside nomograms for identifying patients requiring intensive care unit (ICU) admission and those at risk of poor prognosis or death.MethodsThis study is a 6-year retrospective cohort study conducted among patients presented with acute exposure to CNS xenobiotics.ResultsA total of 143 patients’ records were included, where (36.4%) were admitted to the ICU, and a significant proportion of which was due to exposure to alcohols, sedative hypnotics, psychotropic, and antidepressants (P = 0.021). ICU admission was associated with significantly lower blood pressure, pH, and HCO3 levels and higher random blood glucose (RBG), serum urea, and creatinine levels (P ConclusionThe proposed nomograms yielded significant straightforward and reliable prognostic outcomes predictors in acute exposure to CNS xenobiotics.

Acute clozapine poisoning (ACP) is frequently reported worldwide. We evaluated the efficacy of the Poison Severity Score (PSS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Rapid Emergency Medicine Score (REMS), and Modified Early Warning Score (MEWS) as predictors for intensive care unit (ICU) admission, mechanical ventilation (MV), mortality, and length of hospital stay in patients with ACP. A retrospective cohort study was conducted using records of patients diagnosed with ACP from January 2017 to June 2022 and admitted to an Egyptian poison control center. Analyzing 156 records showed that all assessed scores were significant predictors of the studied outcomes. The PSS and APACHE II score showed the highest area under the curve (AUC) as ICU admission predictors with insignificant variations. The APACHE II score showed the best discriminatory power in predicting MV and mortality. Nevertheless, MEWS exhibited the highest odds ratio (OR) as an ICU predictor (OR = 2.39, and 95% confidence interval = 1.86–3.27) and as a mortality predictor (OR = 1.98, and 95% confidence interval = 1.16–4.41). REMS and MEWS were better predictors of length of hospital stay compared with the APACHE II score. The simpler, lab-independent nature and the comparable discrimination but higher odds ratio of MEWS compared with APACHE II score justify MEWS’ superior utility as an outcome predictor in ACP. We recommend using either the APACHE II score or MEWS, depending on the availability of laboratory investigations, resources, and the case’s urgency. Otherwise, the MEWS is a substantially feasible, economical, and bedside alternative outcome predictor in ACP.

Objectives: Suicide by self-poisoning is a serious public health problem that accounts for global morbidities and mortalities. This work aims to study the incidence, trend, and determinants of suicide by self-poisoning in two Egyptian provinces. Methods: The current study is a bi-designed two-phases observational study carried out in two Egyptian poison control centers including Menoufia Poison Control Center (MPCC) and Tanta Poison Control Center (TPCC). A total of 7,802 patients were enrolled. The first phase of the current study was conducted retrospectively to show the trend of suicide attempts over 2016, 2017, and 2018 when the cases diagnosed as suicide by self-poisoning were extracted from medical record. The second part was conducted prospectively (January 2019-Januaray 2020) among cases of suicide by self-poisoning and accidental poisoning. Results: The current study revealed that incidence of poisoning exposure no matter what its type represented 34.99/100,000 (CI95%: 33.84–36.20) distributed as 28.18/100,000 (CI95%: 27.14–29.26) for suicide by self-poisoning and 6.82/100,000 (6.32–7.36) for accidental poisoning. The suicide by self-poisoning death rate represented 2.08/100,000 (1.90–2.49). The suicide by self-poisoning was significantly associated with young age

Asmaa F Sharif,1 Zeinab A Kasemy,2 Nada A Alquraishi,3 Kawther N Alshaikh,3 Anwar H Alfaraj,3 Eman A Alibrahim,3 Zainb M Alfarej,3 Hawra M Alawami,3 Fatma Alzahraa A Elkhamisy4,5 1Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt; 2Public Health and Community Medicine Department, Faculty of Medicine, Menoufia University, Shiben ElKoom, Egypt; 3College of Medicine, Dar Al-Uloom University, Riyadh, Kingdom of Saudi Arabia; 4Basic Medical Sciences Department, Faculty of Medicine, King Salman International University, South Sinai, Egypt; 5Pathology Department, Faculty of Medicine, Helwan University, Cairo, EgyptCorrespondence: Asmaa F Sharif, Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, 31527, Egypt, Tel +966 581639317, Email asmaa.sherif@med.tanta.edu.egPurpose: Team-based learning (TBL) is an interactive instructional strategy designed to enhance student engagement. Few studies reported that TBL needs to be more interactive, concerns were raised regarding the insufficient instructor feedback, and students feel that TBL gets less attractive with time. One method of boosting students’ interaction and performance is adding an element of challenge or positive stress. Therefore, we hypothesized that inserting an erroneous answer in the answer key would generate an observable improvement in the selected outcomes in terms of better satisfaction, interaction, interest in learning, better academic performance, and better development of competencies compared to traditional TBL.Methods: This randomized controlled trial aimed to determine if inserting an erroneous element in the answer key of a grouped team readiness assurance test (GRAT) would update TBL and whether this intervention would enhance students’ performance and satisfaction.Results: A total of 55 medical students were recruited (88.7% response rate). Erroneous elements were inserted in the answer key of the experimental group and students enrolled in traditional TBL were considered as controls. Compared to the control group (p < 0.001), the experimental group revealed significantly higher academic performances in GRAT and team evaluation test (TET). Analysis of students’ perception of the implemented TBL revealed better perception among the experimental group (33.7 ± 6.4) than the control group (30.1 ± 7.0). Moreover, significantly higher team dynamics were reported among the experimental group than the control group (33.0 ± 6.3 and 27.8 ± 7.6 for both groups, respectively; p = 0.005). The reported advantages were in-depth understanding, easier information retrieval, and development of problem-solving skills. Students considered time and effort as their main limitations.Conclusion: Adding a few erroneous answers in the GRAT is well perceived by students, enhances their learning competencies and overcomes some TBL challenges.Keywords: learning environment, motivation, instructional design, student’s interaction, academic performance, team-based learning

Despite the recent advancement of virtual education during the last pandemic, mastering clinical competencies remains challenging. The current study endorsed Synchronised Video-assisted Clinical Skill lab Sessions (SVCSLS) as a novel instructional design aiming to improve medical students' clinical competencies during virtual learning. The current study is a mixed-method study that was carried out among 210 medical students at a medical college in Saudi Arabia. It was revealed that students viewed SVCSLSs as an effective and safe tool during times of crisis. Students' performance did not show significant variations in all program phases compared with face-to-face learning. SVCSLSs has many advantages, including enjoyment, continuous access to learning material, Self-Directed Learning, fostering recall and memorisation, and enhancing higher cognitive skills. Students suggested that the sessions' content be updated, that workplace-related videos be added, and that constructive feedback is provided. Students recommended updating the contents of the sessions, enriching them with workplace-based videos, and providing constructive feedback. Though SVCSLSs have been proven to be an effective tool, we recommend using them during a crisis rather than replacing the face-to-face mode of learning in normal circumstances.

Background Quality improvement project undertaken by the Ageing and Complex Medicine team to improve the quality and quantity of communication with patients’ relatives. Introduction Visitation restrictions at RAEI since the onset of the COVID pandemic have created barriers to effective communication between patients’ relatives and the medical team. Patients’ relatives were frequently receiving poorly structured information, incorrect information, or even no information. This problem was hospital wide and likely to have affected other trusts. It particularly affected elderly care wards, where the cohort of patients were often less able provide their relatives with updates themselves. We therefore agreed a service standard whereby the medical team would provide a medical update via phone to the patients’ next of kin within 24 hours of admission followed by twice weekly updates by any member of the wider MDT. Our aim was to improve the quality and quantity of communication with the patients’ relatives. Method So far 6 data capture cycles have seen us implement change in various ways such as utilisation of a white board to highlight when updates are due, a staff feedback survey to highlight barriers to providing the service and a relative feedback survey to evaluate their experience. Results Compared to baseline data we have seen an improvement in the quantity of relative updates with most cycles. Conclusion We have improved the quantity of relative updates and embedded it as established culture on Astley ward. Barriers to success include staffing levels, time burden, and low confidence levels amongst junior doctors. Cycle 7 will see implementation of a teaching session for new junior doctor cohorts to improve their confidence. I would like to share our learning and success with the wider hospital and see implementation of the service standard across all wards within the trust.

Manar M Fayed,1 Sanaa A Abdo,2 Asmaa F Sharif1 1Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt; 2Public Health and Community Medicine Department, Faculty of Medicine, Tanta University, Tanta, EgyptCorrespondence: Asmaa F Sharif, Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, El Geish Street, Tanta, Gharbia, 31527, Egypt, Tel +966581639317, Email asma.s@dau.edu.saPurpose: Understanding learning environments is vital for developing curricula. This study aims to evaluate medical students’ achievements and perception of learning environments considering the Forensic Medicine and Clinical Toxicology course as an analog for the curricular transition process.Methods: A cross-sectional study was conducted among undergraduate medical students at the Faculty of Medicine, Tanta University, from August 2020 to October 2021. Using the Dundee Ready Education Environment Measure (DREEM) questionnaire, the perception of 621 students (of which 307 were enrolled in the integrated curriculum and 314 in the traditional curriculum) were compared. Furthermore, the appropriate tests of significance and correlations were used to compare students’ perception according to their enrollment, age, gender, and previous year grade point average.Results: The mean overall DREEM score was 121.04 ± 22.35, implying a more positive than negative learning environment, that is, a more positive learning perception, with students’ perceptions of teachers moving in the right direction, students’ academic self-perceptions getting more on the positive side, more positive attitudes regarding student’s perceptions of the learning environment, and not-too-bad student’s social self-perception. Medical students enrolled in the integrated curriculum showed higher DREEM scores, with significantly better learning and academic self-perceptions (p < 0.05). Knowledgeable, qualified faculties are the most significant characteristic feature in both systems. A significant number of students achieved excellent grades in the integrated curriculum (n = 740 out of 1076, 68.8%) than in the traditional one (n = 470 out of 961, 48.9%) (p < 0.0001).Conclusion: This study revealed a smooth, successful transition from the traditional to integrated curriculum among Egyptian medical students. The main areas for improvements are focusing on factual teaching, implementing student-centered teaching activities, promoting students’ memorizing, and engaging students in activities that may help them enjoy learning.Keywords: learning, education, self-perception, achievement, curriculum, competency-based education

Doxorubicin (DOX) is a frequent chemotherapeutic drug used to treat various malignant tumors. One of the key factors that diminish its therapeutic importance is DOX-induced nephrotoxicity. The first-line oral antidiabetic drug is metformin (Met), which also has antioxidant properties. The purpose of our study was to investigate the underlying molecular mechanisms for the potential protective effects of Met on DOX-triggered nephrotoxicity. Four animal groups were assigned as follows; animals received vehicle (control group), 200 mg/kg Met (Met group), DOX 15 mg/kg DOX (DOX group), and a combination of DOX and Met (DOX/Met group). Our results demonstrated that DOX administration caused marked histological alterations of widespread inflammation and tubular degeneration. Notably, the DOX-induced dramatic up-regulation of the nuclear factor-kappa B/P65 (NF-κB/P65), microtubule-associated protein light chain 3B (LC3B), neutrophil gelatinase-associated lipocalin (NGAL), interleukin-1beta (IL-1β), 8-hydroxy-2′ -deoxyguanosine (8-OHdG), and Beclin-1 in renal tissue. A marked increase in the malondialdehyde (MDA) tissue level and a decrease in the total antioxidant capacity (TAC) were also recorded in DOX-exposed animals. Interestingly, Met could minimize all histopathological changes as well as the disruptions caused by DOX in the aforementioned measures. Thus, Met provided a workable method for suppressing the nephrotoxicity that occurred during the DOX regimen via the deactivation of the Beclin-1/LC3B pathway.

Open reduction and internal fixation of displaced intraarticular calcaneal fractures remain the gold standard of treatment, but the traditional extensile approach has been associated with relatively frequent complications. The current study aims to evaluate the less invasive sinus tarsi approach and to elaborate on the associated complications, risk factors, and outcome predictors. A retrospective observational study was carried out among 39 patients diagnosed with calcaneal fractures that were operatively treated between January 2019 and January 2020 at a level-one trauma center in Riyadh, Saudi Arabia. Patients were assessed regarding the complications, pre- and postoperative Bohler's angle, Gissane's angle, calcaneal height, and return to baseline function. Patients older than 60 years show significantly more complications compared to younger patients (p0.05). Type IV calcaneal fracture, according to Sander's classification, showed significantly more complications than other types (p0.05). There were significant variations in pre- and postoperative Bohler's angle and calcaneal height (p0.05). These variations apply to the Gissane's angle but do not rise to significant results (p0.05). Furthermore, the current study reports a significant moderate direct correlation between delay time and complication incidence (p0.05). In conclusion, the minimally invasive sinus tarsi approach has relatively low complications and excellent clinical and radiological outcomes. Older patients and those who are diagnosed with type IV calcaneal factures, besides those presented with more delay, are more associated with unfavorable complications.

ObjectivesThis study aimed to investigate the technostress creators and outcomes among University medical and nursing faculties and students as direct effects of the remote working environment during the COVID-19 pandemic.BackgroundDue to the current COVID-19 pandemic, shifting to virtual learning that implies utilizing the information and communication technologies (ICTs) is urgent. Technostress is a problem commonly arising in the virtual working environments and it occurs due to misfitting and maladaptation between the individual and the changeable requirements of ICTs.MethodsA multicenter cross-sectional study was conducted in medicine and nursing colleges of 5 Egyptian universities and included both staff members and students. The data were collected through personal interviews, from January to May 2021. All the participants took a four-part questionnaire that asked about personal and demographic data, technostress creators, job or study, and technical characteristics and technostress outcomes (burnout, strain, and work engagement). Furthermore, participants' blood cortisol and co-enzyme Q10 (CoQ10) levels were tested in a random sample of the students and medical staff.ResultsA total of 3,582 respondents participated in the study, 1,056 staff members and 2,526 students where 33.3% of the staff members and 7.6% of students reported high technostress. Among staff members, total technostress score significantly predicted Cortisol level (β = 2.98, CI 95%: 0.13-5.83), CoQ10(β = −6.54, CI 95%: [(−8.52)–(−4.56), strain (β = 1.20, CI 95%: 0.93–1.47), burnout (β = 0.73, CI 95%: 0.48–0.97) and engagement (β = −0.44, CI 95%: [(−0.77)–(−0.11)]) whereas among students, total technostress score significantly predicted cortisol level (β = 6.64, CI 95%: 2.78–10.49), strain (β = 1.25, CI 95%: 0.72–1.77), and burnout (β = 0.70, CI 95%: 0.37–1.04). Among staff members and students, technology characteristics were significantly positive predictors to technostress while job characteristics were significantly negative predictors to technostress.ConclusionThe Egyptian medical staff members and students reported moderate-to-high technostress which was associated with high burnout, strain, and cortisol level; moreover, high technostress was associated with low-work engagement and low CoQ10 enzyme. This study highlighted the need to establish psychological support programs for staff members and students during the COVID-19 pandemic.

BACKGROUND Common in head and neck cancer patients, trismus can make speech and swallowing difficult and can compromise quality of life (QOL). Jaw range of motion exercise therapy may prevent or treat trismus in surgical patients. While the importance of these exercises is well-documented, there is little literature regarding the optimal timing of exercise initiation. METHODS A prospective pilot study investigated the effects of early vs late jaw exercise intervention on postoperative jaw opening and QOL measures, which were examined descriptively. RESULTS Timing of exercise intervention was not found to significantly impact the measured outcomes. However, provisional, descriptive findings showed that jaw opening was significantly associated with multiple QOL measures, with greater jaw opening associated with improved QOL. For certain QOL measures, this positive association was stronger at earlier time points than at later time points. CONCLUSIONS The exploratory findings of this pilot study support further research into possible benefits of early jaw exercise intervention.

Background Schwannomas, benign tumors arising from neurolemmocytes, are the most common type of peripheral nerve tumors. Extracranial schwannomas are most often found in the parapharyngeal space, commonly involving the vagus nerve to cervical sympathetic trunk. Vagal schwannomas present several unique clinical and therapeutic challenges. Methods A comprehensive literature review was conducted on 197 articles reporting 235 cases of cervical vagal schwannomas. Presenting symptoms, treatment approach, and postoperative outcomes were recorded and analyzed. Results Vagal schwannomas commonly present as asymptomatic neck masses. When they become symptomatic, surgical resection is the standard of care. Gross total resection is associated with higher postoperative morbidity compared to subtotal resection. Initial reports using intraoperative nerve monitoring have shown improved nerve preservation. Recurrence rates are low. Conclusion The combination of intermittent nerve mapping with novel continuous vagal nerve monitoring techniques may reduce postoperative morbidity and could represent the future standard of care for vagal schwannoma treatment.

Virtual three-dimensional (3D) scanning of pathologic specimens may allow for improved communication between the surgeon and pathologist, as well as enhanced patient counseling and engagement. We report the rare case of a giant cell tumor of the thyroid cartilage and present a multimodal 3D representation. Preoperative 3D printing of the anatomic structures from cross-sectional imaging, as well as novel ex vivo 3D scanning of the fresh pathologic specimen for virtual 3D specimen mapping, was performed.

Abbreviations: SCP = survivorship care program; TCC = Thyroid Care Collaborative

Cardio- and neurotoxicity of amphetamines play an important role in worsening morbidity, making the initial evaluation of the patient's status a potentially lifesaving action. The current study hypothesized that the S-100β serum level could predict the severity of acute amphetamine toxicity and the in-hospital outcome. The current study is a prospective cohort study conducted on 77 patients diagnosed with acute amphetamine exposure and referred to Aseer Poison Control Center, Saudi Arabia. The patients admitted to ICU showed significantly higher serum levels of S-100β in comparison to those not admitted (p 0.05). Moreover, the S-100β level was significantly elevated among patients with prolonged QTc intervals. Receiver-operating characteristic curve of S-100β serum level as an in-hospital outcome predictor showed that at a cutoff value 0.430 ug/L, the sensitivity of S-100β serum level as severity predictor was 100%, and the specificity was 74.1%. In conclusion, the current study revealed that the S-100β serum level could be used as an outcome predictor in hospital admission cases due to toxic amphetamine exposure and offers an idea about the cardiac and neuronal involvement. This can help select patients who will benefit most from ICU admission and early management and assess the severity of cases in settings where GC-MS is not available.

Objective A subset of patients who undergo major palatomaxillary reconstruction do not initially achieve their intended oncologic and/or reconstructive goals and require additional surgery. We aim to detail the unique management considerations in this patient population. Methods We performed a retrospective review of patients who underwent palatomaxillary reconstruction by the senior author (m.l.u.) between 1998 and 2016. Results Twenty-one patients required multiple reconstructions. The median time to second reconstruction was 17 months. The most common reason for a second reconstruction was for recurrent disease (10 of 21), followed by functional/aesthetic reasons (7 of 21) and osteoradionecrosis (4 of 21). Four patients went on to have a third reconstruction, and two underwent a fourth. A total of 27 reconstructions were performed, consisting of 20 soft tissue free flaps, four vascularized bone free flaps, and three locoregional flaps. Conclusion This patient cohort represents unique oncologic and reconstructive challenges. With long-term follow-up, multiple reconstructions may be required to optimize oncologic and functional/aesthetic outcomes. This is the first series of its kind that details the reasons for, as well as the outcomes of, patients who required multiple reconstructive procedures following initial palatomaxillary reconstruction. Level of evidence 2B Laryngoscope, 130:2349-2353, 2020.

We present the case of a 38-year-old Caucasian female who underwent a total thyroidectomy for papillary thyroid carcinoma. We identified a large anomalous superior thyroid artery (STA) that emerged as a second branch of the external carotid artery and entered the thyroid isthmus superficial to the right sternothyroid muscle. In this case report, we discuss the embryology of the thyroid gland as well as the possible embryological basis for this unusual course of the STA. In doing so, we aim to improve recognition of the potential vascular variations in the thyroid gland, in turn aiding surgeons in the prevention of unnecessary complications and providing insight into the embryologic development of this organ.

Smith-Lemli-Opitz syndrome is an inherited monogenic disorder in which mutations to the 7-dehydrocholesterol (7-DHC) reductase (Dhcr7) gene lead to deficits in cholesterol synthesis. As a result, many patients suffer from gross physiological and neurological deficits. The purpose of this study was to identify a potential abnormal behavioral phenotype in a compound mutant mouse model for Smith-Lemli-Opitz disease (Dhcr7 Δ3-5/T93M ) to further validate the model and to provide potential targets for future therapeutic interventions. We also sought to identify some of the underlying changes in brain function that may be responsible for behavioral differences among groups. The Dhcr7 compound mutant mice were smaller than their single mutant littermates. Both single and compound heterozygous mice made fewer ultrasonic vocalizations when separated from the dam, which may suggest a communication deficit in these animals. Striking increases of the highly oxidizable 7-DHC were observed in the compound mutant mice. 7-Dehydrocholesterol is the precursor to cholesterol and builds up because of decreased function of the mutated Dhcr7 enzyme. Additionally, several differences were noted in the serotonergic system including increased expression of the serotonin transporter and increased uptake of serotonin by isolated synaptosomes. We propose that changes to the oxidative environment during development can have a significant impact on the development of serotonergic function and that this contributes to behavioral differences observed in the mutant mice.

Conventional acinic cell carcinoma (CACC) represents a prototypical low-grade salivary malignancy. Rarely, acinic cell carcinoma (ACC) can demonstrate aggressive features (zones of necrosis, apoptosis, varying nuclear atypia) warranting classification as "ACC with high-grade transformation" (HGT-ACC) or "dedifferentiated" ACC. This study reports ten new cases of HGT-ACC. There is potential for subtlety in recognizing high-grade transformation and distinguishing discrete nodules of necrosis from cytology aspiration changes. We compared immunohistochemical (IHC) profiles, specifically β-catenin (bCAT) and cyclin D1 expression, which have been touted as potentially helpful in this context. We quantified morphology (primary axis nucleus, nuclear area and perimeter) in HGT-ACC and CACC. Clinical outcome is known for eight HGT-ACC patients; three patients developed locoregional or distant metastases, five remained disease-free. Nine of ten HGT-ACC expressed strong, diffuse, membranous bCAT. CACC demonstrated lower intensity of membranous bCAT expression. Strong, diffuse nuclear cyclin D1 was seen in five of ten HGT-ACC whereas no CACC demonstrated cyclin D1 with distribution greater than 50 %. The quantified nuclear morphologic features of CACC and HGT-ACC demonstrated overlapping means values. Maximum values for nuclear primary axis, area, and perimeter were greater for HGT-ACC versus CACC, corresponding to a subpopulation of larger tumor cells in HGT-ACC. The poor outcome associated with HGT-ACC justifies its recognition, which should alter surgical approach with respect to elective neck dissection or possible facial nerve sacrifice. With respect to ancillary IHC studies, strong, diffuse membranous bCAT expression, with or without strong nuclear cyclin D1 ≥ 50 % distribution or Ki67 index ≥ 25 % supports this diagnosis.

Background Aggressive histologic worst pattern of invasion (WPOI) in surrounding soft tissue has been shown to be predictive of higher local recurrence and poorer survival in oral cavity squamous cell carcinoma (OCSCC) patients. This study investigates whether aggressive WPOI can predict the mandibular invasion phenotype. Methods Patients consecutively diagnosed with OCSCC undergoing a mandibulectomy (marginal or segmental) between 2013 and 2018 were reviewed. Senior physicians re-reviewed radiologic scans and pathologic slides of 44 cases. Results Aggressive WPOI (WPOI-4, 5) is significantly associated with infiltrative bone invasion. Non-aggressive WPOI (WPOI-1, 2, 3) is significantly associated with the absence of bone invasion. Conclusions WPOI has become a useful tool that further characterizes the biologic behavior of OCSCC. Potentially, planned surgery may escalate from a marginal to segmental mandibulectomy based on aggressive WPOI for patients with radiographically uncertain cortical status. Further studies are needed to validate the relationship between OCSCC WPOI and mandible status.

Background Osteoradionecrosis (ORN) is a well-known complication following irradiation of head and neck malignancies. ORN commonly occurs in the mandible but is rarely reported in the hyoid bone. Case presentation A 76-year-old female with a history of oropharyngeal squamous cell carcinoma presented with pharyngocutaneous fistula 14 years after primary chemoradiation. Imaging showed necrosis of the hyoid bone. She underwent excision of the hyoid to rule out malignancy. Pathology was negative for carcinoma, but did show extensive fragmentation and bony necrosis consistent with ORN. The patient's clinical course, surgical treatment, and management considerations are discussed here. Conclusions Hyoid ORN should remain in the differential during diagnostic workup of previously irradiated head and neck cancer patients. The presentation of a pharyngocutaneous fistula should prompt workup to rule out malignancy before assigning a diagnosis of ORN.

Erosion in oil and gas production sector is predominantly caused by fine particles’ migration into the processing facilities. Fine particles are mostly transported to the facilities via carrier fluid. Other than sand, the viscosity of the carrier fluid also contributes to the sand erosion phenomenon. However, the impact of viscosity on sand erosion is not fully discovered by previous researchers. Therefore, this paper investigated the impact of fluid viscosity on erosion of carbon steel surface. In the presented work, an experimental rig was fabricated and tested for the study of impact of fluid viscosity on erosion of the carbon steel by considering the water mixed-polyvinyl alcohol as a carrier fluid. The metal coupons were impacted with sand slurries of different viscosities. Scanning electron microscopy along with energy dispersive spectroscopy and Universal scanning probe microscopy were used to analyse the centred and adjunct areas of the coupons. These analyses revealed that the viscous slurry is least effective in removal of metal surface in comparison with the pitting erosion. The obtained results reflected a decrease in erosion rate as the fluid viscosity upsurges and the type of metal surface erosion changes from uniform erosion to pitting erosion by fluid viscosity increment.

Conventional acinic cell carcinoma (CACC) represents a prototypical low-grade salivary malignancy. Rarely, acinic cell carcinoma (ACC) can demonstrate aggressive features (zones of necrosis, apoptosis, varying nuclear atypia) warranting classification as “ACC with high-grade transformation” (HGT-ACC) or “dedifferentiated” ACC. This study reports ten new cases of HGT-ACC. There is potential for subtlety in recognizing high-grade transformation and distinguishing discrete nodules of necrosis from cytology aspiration changes. We compared immunohistochemical (IHC) profiles, specifically β-catenin (bCAT) and cyclin D1 expression, which have been touted as potentially helpful in this context. We quantified morphology (primary axis nucleus, nuclear area and perimeter) in HGT-ACC and CACC. Clinical outcome is known for eight HGT-ACC patients; three patients developed locoregional or distant metastases, five remained disease-free. Nine of ten HGT-ACC expressed strong, diffuse, membranous bCAT. CACC demonstrated lower intensity of membranous bCAT expression. Strong, diffuse nuclear cyclin D1 was seen in five of ten HGT-ACC whereas no CACC demonstrated cyclin D1 with distribution greater than 50 %. The quantified nuclear morphologic features of CACC and HGT-ACC demonstrated overlapping means values. Maximum values for nuclear primary axis, area, and perimeter were greater for HGT-ACC versus CACC, corresponding to a subpopulation of larger tumor cells in HGT-ACC. The poor outcome associated with HGT-ACC justifies its recognition, which should alter surgical approach with respect to elective neck dissection or possible facial nerve sacrifice. With respect to ancillary IHC studies, strong, diffuse membranous bCAT expression, with or without strong nuclear cyclin D1 ≥ 50 % distribution or Ki67 index ≥ 25 % supports this diagnosis.

Background Septic arthritis of the sternoclavicular joint is a rare infection associated with significant morbidity and mortality. Several risk factors for septic arthritis have been reported in the literature ranging from immunodeficiency to intravenous drug use. Case presentation A 63-year-old male previously treated for synchronous squamous cell carcinomas of the epiglottis and floor of mouth presented with tenderness and swelling of the sternoclavicular joint two months after tracheostomy decannulation. Computed tomography and bone scans confirmed the diagnosis of septic arthritis of the sternoclavicular joint. The patient's clinical course, surgical treatment, and management considerations are discussed here. Conclusion Septic arthritis of the SCJ is a rare but serious infection. Once diagnosed, septic arthritis of the SCJ should be promptly treated to prevent further morbidity and mortality.

Background: Paragangliomas are rare neuroendocrine tumors which develop at the site of extra-adrenal paraganglia of the autonomic nervous system, originating in the neural crest. Case presentation: We report the extremely rare finding of 4 concurrent paragangliomas arising bilaterally and simultaneously involving the carotid bodies and superior cervical ganglia of the sympathetic trunk in a 53-year-old man. These tumors were large enough to cause unilateral sympathetic chain dysfunction resulting in Horner's syndrome, in addition to oropharyngeal compression causing obstructive sleep apnea. The patient's clinical course, surgical treatment, and management considerations are discussed here. Conclusion: The morbidity associated with Horner's syndrome is relatively low; therefore, resection of these tumors is less controversial. However, the surgical access to large masses in the parapharyngeal space is more difficult and, in some cases, requires mandibulotomy to ensure that critical neurovascular structures are preserved during the resection. Keywords: Paraganglioma, Parapharyngeal space, Cervical sympathetic chain, Carotid body tumor, Horner's syndrome

Seed priming is one of the methods that can be taken to counteract the adverse effects of abiotic stress, also Seed priming treatments have been used to reduce the damage of aging and invigorate their performance in many crops. Objective of this study was to evaluation the effect of gibberellin on germination characteristics and antioxidant enzymes of safflower seeds after aging. Experimental design was a factorial one with complete randomized design with three replications. The first factor was priming by gibberellin (0 and 50 ppm) and non-primed seeds (control) and the secondary factor was combinations of four levels of aging (0, 1, 3 and 5 days of aging, at 43°C). The results showed that the priming and aging effects on germination percentage, germination index, normal seedling percentage, seedling length, vigor index, catalase and ascorbate peroxidase were significant, but on mean time to germination not significant. Results showed that, the highest germination characteristics such as; germination percentage, germination index, normal seedling percentage, seedling length, vigor index, catalase and ascorbate peroxidase were attained from priming by gibberellins, under non aged conditions. Also, our results indicated that seed aging is related to decrease of enzymes activity and may contribute to low seed germination efficiency, also priming increases enzyme activity and increases enzyme activity with priming treatment may contribute to improve germination characteristics. The general decreases in enzyme activity in the seed lowers the respiratory capacity, which in turn lowers both the energy (ATP) and assimilates supply of the germinating seed.

Priming improves germination rate and seed vigor but reduces longevity of seeds. We examined the possibilities of obatining primed seeds with maintaining high germination quality but with longevity much the same that seeds are not treated. In this study were used different priming treatments for Agropyron elongatum. Then primed seeds were placed at different levels of heat shock. And then all treatments and unprimed seeds were evaluated in standard germination and accelerated ageing test. We found that the desired longevity could be obtained by keeping the seeds under heat shock for four hours at 40°C, after a priming treatment. Decreasing germination and seedling vigour in hydro and hormonal priming did not happaen again due to such a treatment. In addition, following priming, heat shock affects the initial quality of primed seeds in some treatments. Optimal temperature was strongly duration dependent. The method was applied to obtain primed seeds without loss of storability is very similar to those used to induce desiccation tolerance in germinated seeds and acquired thermotolerance in plant vegetative tissues. DOI: http://dx.doi.org/10.4038/jas.v10i1.8045 The Journal of Agricultural Sciences, 2015, vol.10, no1: p.29-40

Wastewater of hospitals creates serious environmental problems since it may contain viruses, poisonous medical materials and heavy materials. Thus, extensive care should be given for such wastes before disposing to surface water or city sanitary network. In this research, a detailed investigation for the wastewater discharged from different departments of Al-Nu'uman general hospital has been performed during the period February – June, 2005. It is found that wastewater discharge from that hospital is 0.76 m3/(day.bed) which is very close to the Iraqi and International health regulations. This research program includes measurements of different wastewater characteristics including BOD = 180 mg/l , COD = 474 mg /l, PO4= = 15 mg/l , SO4= = 108 mg/l , SS = 1979 mg/l , pH = 7.5 , average Temperature of ( 23° C ). The results of this work indicated that the range of Al-Nu'uman general hospital wastewater characteristics fall within the general limits of hospital wastewater characteristics.

Intensive care unit is one of the stressful environments for its staff, especially physicians and nurses. This study was objective to determine anxiety in physicians and nurses working in intensive care units in Yasuj,s hospitals in Iran. This research is an intervention study conducted in Yerevan city in 2009. The number of participants in this study is 150 which are randomly selected. In this study 120 nurses and 30 specialists participated as the working in the intensive care unit of Yasuj,s hospitals in Iran. In the study, a 10-question demographic questionnaire, 20-question situational anxiety, 20-question personality anxiety Berger is used. After codification, the questionnaires Results indicate that average score for the situational anxiety of the nurses has been 46.96, average score for the situational anxiety of physicians has been 39.40 and that average score for the personality anxiety of the nurses has been 40.96, average score for the personality anxiety of physicians has been 36.73. This study provides valuable insight into the actual and perceived stressful experiences of critical care nurses, thus contributing to the ongoing effort to reduce burnout in this population.

Because the sanctions imposed on Iraq by the United Nations, programmed maintenance and wearing parts replacement has not been performed according to schedules in DORA Refinery Wastewater Unit, which resulted in higher phenol content and BOD5 in effluents disposed to river. The investigations showed that two main reasons were behind this problem: Firstly, increased emissions of hydrocarbons in the complexity of refinery equipment and Secondly, the decreased efficiency of the aerators in the biological. During the last few months, phenol average concentration in the effluent, after biological treatment was found to be between 0.06-0.13 mg/L, while COD was exceeding 110 mg/L after treatment in the same period. Considerable enhancement, has been indicated recently, after the following performances: First: Recycling wastewater from some heat exchangers, and the segregation of low and high strength of wastewaters, Second: Minimizing emissions of hydrocarbons from fluid catalytic cracking and steam cracking, Third: Replacement of driving motors of the aerators in the biological treatment unit. After replacement of these units, a significant decrease in phenol concentration was obtained in purified water (0.03-0.05) mg/L and COD of 60 mg/L before the tertiary treatment. It is concluded that a better quality of effluents has been obtained after a series of emissions control and wastewater treatment unit equipment maintenance performances.

Seed priming techniques have been used to increase germination, improve germination uniformity and seedling establishment under stressed conditions. Seed priming was used in rye mountain (Secale montanum) to increase seed germination and tolerance on stress exposure (Cold stress). Rye seeds were treated with water (Hydro priming) and polyetelyn glycol 6000 (Osmo priming). The effect of priming was assessed on germination characteristics under cold stress (at 3°C) for 7 days. Analyze of variance for hydro priming showed that temperature × time of priming interaction was significantly (P < 0.01) for all traits under cold stress and for osmo priming showed that Concentration of PEG × Temperature × Time of priming interaction was significantly (P < 0.01) for all traits under cold stress except seedling dry weight (SDW). For hydro priming the highest germination percentage (GP) was attained from hydro priming at 15±1°C for 16 h (70%), whereas the highest normal seedling percentage (NSP) (22.5%), germination index (GI) (8.57), seedling vigor index (SVI) (38.9) and seedling length (SL) (1.7 cm) were in the hydro priming at 10±1°C for 16 h. For osmo priming the highest germination percentage (GP) (80 and 80.5%), normal seedling percentage (NSP) (48 and 45%), seedling vigor index (SVI) (101.26 and 85.25) and seedling length (SL) (2.11 and 1.89 cm) observed in the osmo priming with concentrations of -9 and -15 bar PEG at 15±1°C for 24 h.

Wastewater of hospitals creates serious environmental problems since it may contain viruses, poisonous medical materials and heavy materials. Thus, extensive care should be given for such wastes before disposing to surface water or city sanitary network. In this research, a detailed investigation for the wastewater discharged from different departments of Al-Nu’uman general hospital has been performed during the period February – June, 2005. It is found that wastewater discharge from that hospital is 0.76 m3/(day.bed) which is very close to the Iraqi and International health regulations. This research program includes measurements of different wastewater characteristics including BOD = 180 mg/l , COD = 474 mg /l, PO4= = 15 mg/l , SO4= = 108 mg/l , SS = 1979 mg/l , pH = 7.5 , average Temperature of ( 23° C ). The results of this work indicated that the range of Al-Nu’uman general hospital wastewater characteristics fall within the general limits of hospital wastewater characteristics.