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Abstract Background Laryngoscopy is a diagnostic procedure utilized in critical care to examine and visualize the larynx through the diversion of upper airway structures. Its primary functions are airway management and tracheal intubation. The objective of this study was to detect the predictors of laryngeal exposure during microlaryngeal surgery (MLS). Methods An analytical cross-sectional study was conducted on a consecutive sample of 100 patients presenting laryngeal lesions that were trans-orally microsurgeries to treat various glottic diseases (biopsies revealed 68% benign lesions such as vocal fold polyps, cysts, and nodules, and 32% glottic masses) and prepared for MLS. Results This study included 100 patients presenting laryngeal lesions from both sexes with the age of 47.0 ± 14.7 years, in multivariate logistic regression analysis, all these parameters were significant predictors for Cormack–Lehane and Italian Grading (P 35, with more protruded mandible (class C), higher Mallampati Index (class III) and shorter mento-sternal distance (≤ 12.5 cm). Conclusions During microlaryngeal surgery, BMI, mandibular protrusion test, Mallampati Index, mento sternal and AOJ extension were significant predictors of Cormack–Lehane and Italian Grading which makes it easier for laryngeal exposure.

Introduction: Silver diamine fluoride (SDF) is a topical treatment for carious lesions and a primary preventative for newly exposed high-risk surfaces such as fissures and roots in the first molars. Using potassium iodide (KI) after applying SDF has been recommended as a way of reducing the severity of black staining, as well as preserving its antibacterial effect useful in deep caries. Objective: The objective of this research was to compare the antibacterial effect of SDF, with and without KI, on Streptococcus mutans (S. mutans) and dental biofilm. Methods: The antibacterial effects of SDF, KI, and the combination of both were measured using three different techniques (inhibition halo, minimum inhibitory effect [MIE], and colony-forming unit [CFU], testing). Results: The results were then subjected to statistical analysis. Analyzed by means of the Kruskal–Wallis statistical test, the inhibition halos yielded a value of P = 0.3309. Using the MIE test, only the SDF treatment produced an antibacterial effect, at 10%, compared to the KI group, with P = 0.001. Finally, the CFU test revealed a total absence of colonies for all three reagents. All three substances analyzed achieved total inhibition of S. mutans. SDF is effective even in its minimal commercial concentration. Its antibacterial capacity decreases with the addition of KI. Conclusions: The three substances analyzed at their maximum concentrations exhibited an antibacterial effect against S. mutans, resulting in total inhibition.

Abstract Background Cervical incompetence is a failure of the cervix to retain the products of conception throughout pregnancy, which results into cervical dilatation and preterm delivery. Many methods are conducted for early detection of cervical shortening, ripening and eventually dilatation to lessen the incidence of the preterm delivery, which is responsible for about 75% of neonatal comorbidities. Ultrasound plays an important role in the diagnosis and early detection of cervical incompetence. Elastography is a relatively new technique, which investigates into another important factor for cervical insufficiency which is “tissue stiffness”. The process of early cervical ripening, which is an important and main step in spontaneous preterm delivery, precedes cervical shortening and renders the human cervix soft which can be diagnosed through the color-coding method of the sonoelastography technique. The aim of this study is to determine the value of cervical elastography as a predictor of spontaneous preterm labor and validate the role of strain ratio in such technique. Results In our study, we examined the pregnant females by transvaginal conventional B-mode ultrasound and complementary elastography technique and recorded the elastography index of their cervix, internal os and external os together with measuring the amount of strain and strain ratio at internal and external os. Conclusions We concluded that women who had preterm delivery did have higher strain and elastography index as their cervices were softer than those who had full-term deliveries. Elastography therefore can be a reliable method for the prediction of preterm delivery.

The role of urban development is to restore the ecological system by making parks more efficient and sustainable. The sustainability of historical parks is concerned with more than just conservation; as it contributes to the pillars of sustainability as well as restoring nature conservation areas. Furthermore, historic parks offer demands regarding how to fulfill modern visitors’ needs, since these needs have not been provided in the previous era, and these parks are frequently susceptible to deterioration. This research aims to apply potential strategies to revive abandoned historical parks in Alexandria, which are considered of a significant value to national and international heritage assets, due to their influence on the residents’ socio-cultural heritage. This aim is achieved through two main dimensions. The first one describes the development of restoring historical parks throughout the ages, identifies parks’ laws and charters, the investigation of parks, the reasons for parks' deterioration in Egypt, and the requirements for sustainable parks. The second one is an application of the strategic criteria to different international parks to measure the parks’ sustainability. This leads to an analysis of how these strategies can be implemented at Antoniadis Park. The research concludes that historical park restoration facilitates eco-friendly development by recognizing the sustainability pillars and their intersection.

Overpopulation and resource shortages are becoming increasingly important challenges to our global agenda. Cities are rapidly evolving, expanding in size and density while confronting major challenges such as migration, deteriorating healthcare, and transportation issues. Studying Egypt's overall urban development tendencies, as well as the continuously growing population in Greater Cairo, it becomes clear that developing new urban communities to accommodate this increase is a requirement. The major goal of any city pursuing evolution is to solve its issues to improve the quality of life and services for its residents, which ties into the goal of a 'smart city,' as it maximizes the use of technology to satisfy the current and the future needs. This paper discusses the strategy for transforming the old Cairo capital into a new administrative capital (NAC), which is intended to be a smart capital city. It also discusses smart city dimensions, smart city performance evaluation criteria, and smart city technologies such as implementing smart applications in various city sectors, all of which contribute to the city's continued development.

Abstract Background Cardiovascular disease (CVD) is considered a major cause of death in renal insufficiency (RI). Contributing genetic factors is a recent focus of research. This study aims to elucidate apolipoprotein E (APO-E) and plasminogen activator inhibitor 1 (PAI-1) gene polymorphisms in RI children associated with CVD. Methods We studied 50 cases with chronic kidney disease (CKD) associated with CVD, and 30 healthy controls. Study sample was grouped as one on conservative treatment, the second on hemodialysis and the third was posttransplant. PAI-1 and APO-E gene polymorphisms were investigated using allele-specific polymerase chain reaction (AS-PCR) and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) respectively. Results 4G4G and 4G5G were the most common PAI-1 polymorphism denoting high association of 4 G allele in renal insufficiency associated with CVD with absent link to dyslipidemia, echocardiography changes or thrombosis. E3E3 was the most common among APO-E polymorphism without relation to dyslipidemia or thrombosis. Dyslipidemia was significantly linked to thrombosis. The study confirmed the role of dyslipidemia and hemodialysis in promoting thrombosis. Conclusion Although PAI 4G Genotyping did not show significant association with echocardiography severity or thrombotic severity, yet genetic expression for high levels of PAI in plasma is expected in response to CRI factors known to trigger its release, in addition to those related to dialysis. APO-E3E3 genotyping showed a significant association with echocardiography severity as it enhances APO-A which contributes to CVD. The current study confirmed a significant association between dyslipidemia and CVD; however, the prevalent patterns 4G and E3E3 did not show a significant association with dyslipidemia. The genetic role for APO-A, B, O, or even other isomers for APO-E should be further studied as well.

Introduction: Silver diamine fluoride (SDF) is a topical treatment for carious lesions and a primary preventative for newly exposed high-risk surfaces such as fissures and roots in the first molars. Using potassium iodide (KI) after applying SDF has been recommended as a way of reducing the severity of black staining, as well as preserving its antibacterial effect useful in deep caries. Objective: The objective of this research was to compare the antibacterial effect of SDF, with and without KI, on Streptococcus mutans (S. mutans) and dental biofilm. Methods: The antibacterial effects of SDF, KI, and the combination of both were measured using three different techniques (inhibition halo, minimum inhibitory effect [MIE], and colony-forming unit [CFU], testing). Results: The results were then subjected to statistical analysis. Analyzed by means of the Kruskal-Wallis statistical test, the inhibition halos yielded a value of P = 0.3309. Using the MIE test, only the SDF treatment produced an antibacterial effect, at 10%, compared to the KI group, with P = 0.001. Finally, the CFU test revealed a total absence of colonies for all three reagents. All three substances analyzed achieved total inhibition of S. mutans. SDF is effective even in its minimal commercial concentration. Its antibacterial capacity decreases with the addition of KI. Conclusions: The three substances analyzed at their maximum concentrations exhibited an antibacterial effect against S. mutans, resulting in total inhibition. [ABSTRACT FROM AUTHOR]

This case study provides evidence-based suggestions for the use of Question and Answer discussion forums for improving quality and assessment of online learning. General online discussion forums are accessible at any time to all subscribers, making it possible for some learners to update, concur with or paraphrase discussions posted earlier by their peers or the tutors. Consequently, the usefulness of such forums in individual and constructivist learning is compromised, especially when "correct" responses are posted early on by participants. The Question and Answer (Q & A) version of discussion forums significantly addresses such inadequacies by restricting access to forum subscribers until they have made a post. We focus on Public Health learners' perceptions of Q & A discussion forums implemented at Hamdan Bin Mohammed Smart University, UAE. Analyses of learners' perception surveys of 25 participating Master of Public Health learners and 8 Bachelor of Health Administration learners reveal that the Q & A discussion forum platform offers distinct advantages over general discussion forums in synergising individual and co-operative learning in Public Health training.

Abstract Empty nose syndrome (ENS) is an iatrogenic disorder most often recognized by the presence of paradoxical nasal obstruction despite an objectively wide patent nasal cavity. It occurs after inferior and/or middle turbinate resection; however, individuals with normal turbinates and intranasal volume may also complain of ENS. Its pathophysiology remains unclear, but it is probably caused by wide nasal cavities affecting the neurosensitive receptors and inhaled air humidification. Neuropsychological involvement is also suspected. Not every patient undergoing radical turbinate resection experiences the symptoms of ENS. ENS can affect the normal breathing function of the nasal cavity, with subsequent deterioration in patients’ quality of life. The diagnosis is made on the basis of the patients’ history, endoscopic examination of the nasal cavity, imaging (computed tomography imaging and functional MRI), and rhinomanometry. Prevention is the most important strategy; thus, the inferior and middle turbinate should not be resected without adequate justification. Management is problematic including nasal cavity hygiene and humidification, with surgery reserved for the most severe cases. The surgery aims at partial filling of the nasal cavity using different techniques and implant materials. In this paper, we review both the etiology and the clinical presentation of ENS, and its conservative and surgical management. Core tip Empty nose syndrome (ENS) is encountered after inferior and/or middle turbinate resection; however, it can occur in patients with seemingly normal turbinates. Rhinologists should avoid routine resection of the inferior and middle turbinates. It is not certain why some patients develop ENS, whereas others do not. The frequent association with psychiatric disorders and possibly psychosomatic pathologies indicate the possible role of psychological stress in some patients. Its diagnosis relies on clinical suspicion and physical examination. Nasal augmentation surgery can improve the quality of life of patients by restoring nasal anatomy toward the premorbid state.

Introduction: Immunosuppressive agents are recommended for the management of children with steroidresistant (SRNS), frequently-relapsing (FRNS), and steroid-dependent idiopathic nephrotic syndrome (SDNS). This study evaluated the efficacy of immunosuppressive agents in these cases. Methods: This is a retrospective analysis of the records of 130 pediatric cases recruited from a tertiary-care center over a period of two years. They were divided into two groups: 51 patients with SRNS (Group I) and 79 cases with SDNS and FRNS (Group II). They were treated with immunosuppressive agents in addition to steroids, either as double- or triple-combination therapy. Complete or partial remission was considered a good response. Results: In group I, the proportions of good response to cyclophosphamide, cyclosporine A, and mycophenolate mofetil were 48.6, 60, and 80%, respectively (p = 0.162). In group II, the resistance rate was significantly higher with levamisole than with cyclophosphamide and azathioprine (p = 0.046). Leukopenia was reported infrequently after the administration of cyclophosphamide or azathioprine. The most serious adverse reaction was to cyclosporine A, which induced nephrotoxicity (6.4%), while no adverse effects related to levamisole were reported. Histopathological diagnoses were available in only 39 patients. Conclusion: The high potency of cyclosporine with steroids recommends its use in patients with idiopathic SRNS with a normal glomerular filtration rate. Its efficacy is augmented when combined with mycophenolate mofetil. Cyclophosphamide, orally or as intravenous boluses, together with alternate-day steroids, could be a good option outside the peripubertal age. The outcomes of FRNS and SDNS could be improved by encouraging compliance with the use of levamisole.

The objective of the present study was to illustrate the changes in physicochemical properties in ultra-high temperature (UHT) milk packed into a pouch and Tetra Brik during storage. UHT milk samples were kept at 5 and 25 °C for 3 months and regularly analyzed monthly. During storage, significant increases (p < 0.05) in titratable acidity (TA), water-soluble nitrogen (WSN), and non-protein nitrogen (NPN) when UHT milk was packed into pouch versus Tetra Brik and stored at 25 versus 5 °C. Neither type of packaging nor storage temperature affect pH values during storage. Spore-forming bacterial (SFB) count was always higher in UHT milk packed into pouch versus Tetra Brik. Refrigerated storage kept UHT milk without detectable SFB compared to UHT milk held at 25 °C. Pouch packages were responsible for the migration of phthalate derivatives [dimethyl phthalate "DMP", diethyl phthalate "DEP", dibutyl phthalate "DBP", and di-(2-Ethylhexyl) phthalate "DEHP"] into milk with significantly greater levels than milk filled into Tetra Brik. The total sensory scores were decreased significantly during storage, which was more pronounced in UHT milk filled into pouch versus Tetra Brik or stored at 25 °C versus 5 °C. It is concluded that UHT milk filled into Tetra Brik stored at 5 and 25 °C is better in terms of quality and safety indexes than such filled into a pouch. [ABSTRACT FROM AUTHOR]

During Trypanosoma cruzi infection, oxidative stress is considered a contributing factor for dilated cardiomyopathy development. In this study, the effects of astaxanthin (ASTX) were evaluated as an alternative drug treatment for Chagas disease in a mouse model during the acute infection phase, given its anti-inflammatory, immunomodulating, and anti-oxidative properties. ASTX was tested in vitro in parasites grown axenically and in co-culture with Vero cells. In vivo tests were performed in BALB/c mice (4–6 weeks old) infected with Trypanosoma cruzi and supplemented with ASTX (10 mg/kg/day) and/or nifurtimox (NFMX; 100 mg/kg/day). Results show that ASTX has some detrimental effects on axenically cultured parasites, but not when cultured with mammalian cell monolayers. In vivo, ASTX did not have any therapeutic value against acute Trypanosoma cruzi infection, used either alone or in combination with NFMX. Infected animals treated with NFMX or ASTX/NFMX survived the experimental period (60 days), while infected animals treated only with ASTX died before day 30 post-infection. ASTX did not show any effect on the control of parasitemia; however, it was associated with an increment in focal heart lymphoplasmacytic infiltration, a reduced number of amastigote nests in cardiac tissue, and less hyperplasic spleen follicles when compared to control groups. Unexpectedly, ASTX showed a negative effect in infected animals co-treated with NFMX. An increment in parasitemia duration was observed, possibly due to ASTX blocking of free radicals, an anti-parasitic mechanism of NFMX. In conclusion, astaxanthin is not recommended during the acute phase of Chagas disease, either alone or in combination with nifurtimox.