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Abstract To evaluate the effect of combining different bioactive root-end filling materials with composite bone graft (xenogeneic mixed with autogenous bone fragments) on the healing process of periapical tissues after endodontic micro-surgery procedure. In this triple-blinded clinical trial, 56 patients were divided into 2 main groups (28 each) according to the root-end filling material and 2 subgroups according to the presence or absence of the composite bone graft material. Group I: MTA root-end filling (n = 28) in which there are Sub-group A: without bone graft (n = 14) and Sub-group B: with composite bone graft (n = 14). Group II: TotalFill root-end filling (n = 28) in which there are Sub-group A: without bone graft (n = 14) and Sub-group B: with composite bone graft (n = 14). Healthy patients whose ages range from 20 to 50 years with small-to-medium size radiolucency in CBCT related to single-rooted maxillary teeth were included in this study. Patients were assigned a number starting from 1 to 56 and were randomly allocated to four test groups (2 main groups and 2 sub-groups) following simple randomization procedure guidelines described by IBM SPSS V23 (IBM USA) statistical analysis software. This trial was triple-blind where the patient, the outcome assessors, and the main operator were blinded to the applied intervention. Every patient was evaluated clinically and by CBCT at two main observation periods: presurgical and 12-month post-operative. They were also examined and evaluated clinically and radiographically through periapical x-rays after one week, three, and six months. Statistical analysis was performed with IBM SPSS Statistics for Windows Version 23.0. Armonk, NY: IBM Corp. Of the 56 patients enrolled in the study, 49 patients were available for the final analysis. All groups showed no statistically significant differences with regard to healing or success rates at the 12-month follow-up mark. No adverse effects were encountered. Results showed that high success rates were achieved using MTA and TotalFill in the healing of periapical lesions after endodontic surgery. The addition of bone graft in small-to-medium size lesions did not affect the success rate of endodontic surgeries.

Water scarcity is one of the major critical affecting arid climate countries. In addition, population growth and climate change are threatening the sustainable development of water resources in the upcoming decades. Therefore, managing groundwater can solve water scarcity such that sustainable development is ensured for future generations. Hence, it is crucial to assess the current quantity of groundwater by analyzing groundwater variables. Thus, natural groundwater recharge could be utilized as an indicator to assess groundwater quantity conditions. This study aims to estimate natural groundwater recharge in an arid unconfined aquifer. El-Qaa plain in Sinai, Egypt was chosen as a case study. Recharge was estimated taking into consideration spatial and temporal variability. To accomplish this, the WetSpass (Water and Energy Transfer between Soil, Plants, and Atmosphere under quasi-Steady State) model was applied. The model was run using morphological, landuse – land cover and climate data from 1986 to 2015 with a monthly time step. To calibrate the model, the isotope signature of δ18O and δ2 H of water was analyzed to determine the natural groundwater recharge of the aquifer. The obtained recharge value was utilized as a reference value for the calibration process. The results were validated using a finite-difference groundwater flow model (MODFLOW). The recharge values were imported to MODFLOW followed via a transient run from 2000 to 2011. The validation was conducted by comparing the simulated groundwater level with the observed ones. After validation process, the inter-annual and seasonal variability of recharge were determined, and a relationship between recharge and other hydrological parameters was deduced. In addition, the recharge distribution was mapped to depict the recharge spatial variability. The results show that the current recharge rate ranges from approximately 8.10 to 16.62 mm/yr, with a mean annual recharge rate of nearly 12.36 mm/yr. The study might be useful for hydrogeologists for determining potential recharge in the study area, groundwater modelers for developing a reliable groundwater flow model, and decision-makers for planning appropriate future sustainable development through water resources management.

Abstract Egypt’s urban communities face many threats, including, pluvial floods, heat waves, and lack of publicly accessible urban green spaces. Nature-based solutions such as constructed wetlands (CWs) present a promising solution that could offer a wide range of ecosystem services (ES). However, the adoption of CWs is challenged by the lack of local planning guides and uncertainty about potential benefits. There are various models and tools available for quantifying and valuing ES, however, many of them are either highly complex or require extensive data and expertise. The aim of this paper is to develop a GIS-based multi-criteria decision model to select CW sites based on the supply and demand of ES. The model is to operate on three main stages: (i) demand: based on the need for risk reduction or benefit provisioning, (ii) potential sites (PSs): identify and score suitable sites for establishing a CW, and (iii) supply: define the service benefiting areas (SBA). An experimental approach is used, where the model is tested on New Damietta, an Egyptian Mediterranean city, proving the model is a reliable decision-making tool during preliminary urban planning stages due to its practicality, flexibility, and reasonable data requirements.

Abstract Background Hepatic steatosis has become a major worldwide health problem, so assessment of hepatic steatosis in potential living donors is crucial prior to liver transplantation. Until now liver biopsy (LB) is considered the gold standard for diagnosing steatosis before transplantation, however steatosis assessment using imaging modalities, such as computerized tomography (CT), would be better for the donor, due its non-invasiveness. This study aimed to assess the efficacy of CT as a semiquantitaive tool for liver steatosis assessment in liver donors in comparison to liver biopsy results. Methods This cross-sectional study was carried out on 53 potential liver graft donors. All patients were subjected to non-contrast CT of the abdomen, tru-cut liver biopsy, and histopathological evaluation. The CT liver attenuation (CTL), the hepatic/splenic CT attenuation ratio (CTL/S) and difference between hepatic attenuation value and splenic attenuation values (CTL–S) were determined as well as the correlations of these indices and the findings of Liver biopsy (LB) were compared. Results According to the hepatosteatosis grades in the pathology results, the patients were divided into two groups: group A: 38 patients with grade 0 hepatosteatosis and group B: 15 patients with grade 1 and 2 hepatosteatosis. CTL, CTL–S, CTL/S, ratio of mean right hepatic lobe and splenic attenuation (RT/S) and ratio of mean left hepatic lobe and splenic attenuation (LT/S) were found to be effective in the diagnosis of hepatosteatosis grades at cutoff values ≤ 55.4, ≤ 8.7, ≤ 1.17, ≤ 1.1548 and ≤ 1.2971 with 80%, 80%, 73.3%, 86.7% and 86.7% sensitivity and 71.1%, 56.8%, 73.7% 71.1% and 50.0% specificity respectively. Also, CTL/S was found to be very effective in the diagnosis of grade II hepatosteatosis at cutoff values ≤ 0.9 with 100% sensitivity and 100% specificity. There was significant negative correlations between the CT indexes and degree of hepatosteatosis. Conclusions Compared to biopsy results, CT noninvasive indices strongly predicted the presence of hepatosteatosis, which can help in avoiding the necessity for this invasive technique.

Abstract Objective The middle ear has compartments with the presence of anatomic variations. Transcanal endoscopic middle ear surgery facilitates the exploration of every single compartment with the least possible tissue dissection. Methods This study was conducted on 250 middle ears of patients who had endoscopic ear surgery (tympanoplasty and stapedotomy) at the period of the study with endoscopic recording of the data. Intraoperative examination of the pro, retro, and hypotympanum was performed with 0, 30, and 45° endoscopes and data was collected, processed, and analyzed with Statistical Package for Social Sciences (SPSS). Results Quadrangular conformation (64%), type B (shallow subtensor recess) (64.8%), and type A protinuculum (ridge) were the commonest in the protympanum. Type A jugular bulb which lies below the level of the bony annulus was the commonest finding (75.6%) in the hypotympanum. Type A (ridge) variant was the commonest finding of ponticulus, subiculum, and finiculus 88.4%, 64.8%, and 72.8% respectively in the retrotympanum. Type B (deep) ST 53.6% was the commonest regarding sinus tympani. Type A (present) subcochlear canaliculus, type B (oblique) fustis and type B (absent) RW membrane were the most common regarding the round window region. Conclusion Good knowledge of the anatomical variations of the middle ear has great surgical importance. The study showed variations of the known structures from other studies that can be attributed to being an in vivo study, racial differences, and a larger sample size.

Restrictive allograft syndrome (RAS) is an aggressive variant of CLAD characterized by progressive restrictive ventilatory decline and persistent pleuro-parenchymal changes that can be seen on chest CT. We identified four lung transplant recipients with a progressive restrictive ventilatory defect due to lymphocyte-predominant exudative pleural effusions, but no pleuro-parenchymal abnormalities typical of RAS. Using molecular analysis, we also found increased levels of previously described immune markers of RAS, including NFkB, 20S proteasome, lipocalin, TNFα, and TGFβ, within the circulating small extracellular vesicles of the remaining living lung transplant recipient. Despite the absence of lung parenchymal changes, these patients had a poor prognosis with rapid deterioration in allograft function and no response to pleural-based interventions such as thoracentesis, decortication, and pleurodesis. We hypothesize that these cases represent a distinct CLAD phenotype characterized by progressive restriction due to pleural inflammation, lymphocyte-predominant pleural effusion, resultant compressive atelectasis, and eventual respiratory failure in the absence of lung parenchymal involvement.

Background: Obesity is associated with chronic low-grade inflammation and severe COVID-19. Interleukin 6 (IL6) is a key mediator of cytokine storm hyperinflammation. However, it is unknown if IL6 is involved in the link between obesity and COVID-19 outcomes. Methods: Observational retrospective research was conducted between September 8, 2020, and September 30, 2021. BMI-varying COVID-19 patient data were collected. Demographic, clinical, radiographic, and laboratory variables were assessed. COVID-19 outcomes were examined in relation to body mass index () and IL6 levels. Results: More than half of the participants (60.4 %) were elderly individuals. A quarter of the study population was non-obese, and 6.6 % had 3rd-degree obesity. Individuals with normal weight and class I obesity had higher IL-6 levels (70.1 % and 75.6 %, respectively). Severe cases were more likely to have higher IL-6 levels than non-severe cases (p

Arthroscopic repair of massive retracted rotator cuff tears is very challenging with a high incidence of retears. Many techniques have been described to improve the outcomes of arthroscopic repair. In this technique, a superior capsular reconstruction using the long head of the biceps is combined with margin convergence repair aimed at improving the mechanical strength of the repair. The long head of the biceps is used as a superior capsular reconstruction to stabilize the humeral head and prevent proximal migration. Moreover, margin convergence provides an efficient gap filling between remnants of the supraspinatus and infraspinatus tendons to restore an efficient rotator repair in anatomical, biological, and tension-free fashion.

Abstract Background Diabetes and arterial hypertension are the two most common types of non-communicable diseases (NCDs) impacting people globally. There is no prior research on the Syrian population’s knowledge and treatment of hypertension and diabetes. It is crucial to investigate how the Syrian public understands and perceives these disorders in order to address the increased incidence and prevalence of hypertension and diabetes. This research intends to assess the level of hypertension and diabetes-related awareness, knowledge, attitude, and practices among Syrian individuals. Methods A cross-sectional survey was conducted online between 1 August and 25 August 2022. The questionnaire for the study was developed based on previous research, and the inclusion criteria for the sample were Syrian residents older than 18 who presently live in Syria. The survey consisted four sections: sociodemographics information, WHO STEPS survey instrument on knowledge of and lifestyle determinants for hypertension and diabetes, respondents’ knowledge of and comprehension of hypertension and diabetes, and respondents’ awareness of these disorders. Results Among 976 participants, 65.8% were females. the most common causes for hypertension from the perspective of participants were (90.1%) for stress, (87%) High salt consumption, (82.1%) genetics, (78.2%) old age, (78%) obesity (69%) anxiety, and (38.6%) for drug usage. Primary and middle school educational status participants had greater hypertension knowledge (92.3%) than other educational levels. There was a statistical significant difference between the knowledge toward the hypertension and the drinking alcohol, which the nonalcoholic knowledgeable persons were the most common (819 / 976)(P

The aim of this surgical technical note is to provide a more secure option to prevent possible graft loosening with all-inside anterior cruciate ligament (ACL) reconstruction. A triple strategy is used. First, a fixed loop cortical device is used on the femoral side. Second, an internal brace augmentation for ACL graft is employed to prevent graft loosening during early postoperative period. Lastly, tying off the sutures of tibial adjustable loop after retensioning to secure its locking mechanism from slippage.

Cancer immune evasion is one of the principal mechanisms leading to the progression and metastatization of the disease. Despite the migration and infiltration at the tumor site of immune cells, multiple factors can influence the composition of hot or “immune-sensitive” tumors and cold or “immune-resistant” tumors. Among the multiple mechanisms responsible for the make-up of the tumor microenvironment are the expression levels of major histocompatibility molecules (MHC) and of the antigen processing machinery, the metabolic network, hypoxia, and the secretion of pro-inflammatory molecules (e.g., cytokines, chemokines, and growth factors). Moreover, the different triggered pathways can mediate the reprogramming of activated, memory, effector, or regulatory/tolerogenic subtypes of immune cells (T, NK, dendritic cells, and macrophages). Recent studies have focused on the role of cancer metabolism in evading immune surveillance through the action of the active tryptophan catabolic enzyme indoleamine 2,3-dioxygenase (IDO). Immune suppression and evasion mechanisms in cancer cells are now being extensively studied with a special focus on developing immunotherapy strategies, such as the targeting of immune checkpoints (programmed cell death protein 1/programmed death ligand 1 (PD-1/PD-L1), Cytotoxic T-lymphocyte antigen-4 (CTLA-4)), adoptive cell therapy or cancer vaccines. In this review, an overview of the underlying mechanisms of cancer immune evasion and the efficacy of the therapeutic targets and agents to overcome the immune escape are described.

Abstract Background and purpose Diabetic kidney disease (DKD) is highly prevalent among patients with diabetes mellitus. It affects approximately 20% of diabetic patients, who are believed to be more than 400 million individuals. The objectives of the present work were to assess patterns of albuminuria and determine microalbuminuria predictors among patients living with type 2 diabetes (T2D) who attended the family medicine department of Jazan Armed Forces Hospital. Methods A case–control design was used and included two groups (n, 202/group), one with microalbuminuria and the other with a normal urine albumin/creatinine ratio (ACR). Data regarding patient history, glycosylated hemoglobin (HbA1c), lipid profile, renal function tests, ACR, ASCVD (atherosclerotic cardiovascular disease) risk, etc., were collected. Results The prevalence rates of microalbuminuria and macroalbuminuria were 26.4% and 3.9%, respectively. HbA1c was significantly higher in patients with microalbuminuria (9.3 ± 2.2; P˂0.001) and macroalbuminuria (10.5 ± 2.3; P˂0.001) than in those with normal ACR (8.3 ± 1.9%). The predictors of microalbuminuria were poor glycemic control with HbA1c ≥ 7% {OR, 2.5 (95% C. I, 1.5–4.2)}; hypertension {(OR, 1.8 (95% C. I, 1.2–2.8)}; estimated glomerular filtration rate (eGFR) of ˂90 mL/min/1.73 m2 {OR, 2.2 (95% C. I, 1.4–3.6}; smoking {OR, 1.3 (95% C. I, 0.7–2.6}; and body mass index {OR, 1.05 (95% C. I, 1.01–1.09}. Conclusion Microalbuminuria is highly prevalent among patients with type 2 diabetes and is associated with poor glycemic control and hypertension, necessitating aggressive and timely screening and treatment.

Chondroblastoma is a rare benign cartilaginous lesion located mostly in the epiphyses of the long bones. The most common locations are the proximal tibia or femur, distal femur, and proximal humerus. Open curettage and bone grafting constitute the mainstay treatment for this condition. Few reports have documented the use of arthroscopy in tumor surgery owing to the problem of inadequate removal and the difficulty of bone graft delivery to the tumor cavity. The bazooka technique should solve these 2 main problems. In this article, arthroscopic curettage and grafting are described for the treatment of juxta-articular proximal humeral chondroblastoma to lessen postoperative pain and thus enable early mobilization and a quicker rehabilitation in skeletally immature patients.

Abstract Background DEXA scan could be unavailable at some health centers, and radiologic examination of the mandible and oral cavity is considered more commonly used radiologic test that can predict, diagnose, or even follow-up on any defect in bone mineralization. The aim of this study was to elucidate the ability of panoramic radiograph to detect osteoporosis in rheumatoid arthritis patients and correlate panoramic mandibular index with RA disease activity and severity parameters. Results The sensitivity of panoramic mandibular index for diagnosis of osteoporosis was 96% in group Ι (primary OP) and 70% in group ΙΙ (RA patients). The positive predictive value of PMI was 67% in group Ι and 55% in group ΙΙ. The negative predictive value of PMI was 34% in group Ι and was 46% in group ΙΙ. The cutoff value of PMI for diagnosis of OP was ≤ 0.31 in group Ι and ≤ 0.17 in group ΙΙ. In group I, there were significant correlations between panoramic mandibular index and patient’s ages, weights, T score at L1-4, T score at femoral neck, and T score at forearm while there were insignificant correlations between PMI and patients’ heights. In group ΙΙ, there were significant correlations between PMI, patients’ ages, weights, disease durations, SHARP score, ESR, RF, T score at L1-4, T score at femoral neck, and T score at forearm, while there were insignificant correlations between PMI and patients’ heights, DAS, and CRP. Conclusions Panoramic radiography could have a potential usability in the diagnosis of osteoporosis in rheumatoid arthritis patients regardless of displaying insignificant correlation with disease activity.

Abstract Background Enhancement washout technique in solid renal masses using multidetector computed tomography (MDCT) can differentiate different type of lesions. 99 Patients who are presenting with suspected renal masses or renal tumour for staging are included in this study. CT examination are carried out at urology and nephrology centre using MDCT. The attenuation values (Hounsfield Unit) will be assesed for each lesion on the pre enhanced, corticomedullary, nephrographic and delayed phases. Washout ratio will be calculated for each phase of enhancement in comparison to the unenhanced attenuation value. The characteristics of enhancement-washout will be correlated with the final histopathological diagnosis. Results Early enhancement and washout pattern was noted in 54 renal lesions (54.5%) representing 4 types of renal lesions; Oncocytoma (n = 13), clear cell renal cell carcinoma (n = 16), Chromophobe renal cell carcinoma (n = 15) and unclassified renal cell carcinoma (n = 10).Prolonged enhancement pattern was noted 45 lesions (45.4%); PRCC (n = 14), 10 case of lipid poor AML (n = 10), metanephric adenoma (n = 10) and Xp11 RCC (n = 11). High pre-contrast attenuation was noted in Xp 11RCC showing attenuation value 41.7 ± 6.823HU. The highest CMP values were noted in CCRCC (151.9 ± 20.4) followed by oncocytomas (137.6 ± 19.15HU) and then CHRCC (123.6 ± 16.6 HU)while the lowest values were noted in Metanephric adenoma)57.1 ± 17.4HU)and followed by PRCC (59.9 ± 4.8)and followed by lipid poor AML (79.17 ± 13.666) and RCC unclassified (89.06 ± 18.1). Conclusions Four-phase MDCT (the unenhanced, corticomedullary, nephrographic, and excretory phases) evaluate role of MDCT in differentiation of solid renal masses.

Abstract Background Brachial plexus block has substituted general anesthesia in the majority of patients planned for upper limb surgeries as it avoids the undesired effects of the medications used in general anesthesia as well as the stress response associated with airway manipulation. Opioid agonist–antagonists such as nalbuphine are used as adjuvant to improve the anesthetic properties of bupivacaine. Verapamil has an additive effect in brachial plexus blockade in the form of decreasing the consumption of analgesics in the postoperative period with reducing onset time and extending the duration of motor and sensory blockade. The aim of this study is to investigate the adjuvant effect of verapamil versus nalbuphine to 0.5% bupivacaine in brachial plexus block as regards onset, duration of sensory and motor blockade and postoperative analgesic augmentation. The study is randomized, prospective, double-blinded, comparative study where 90 patients subjected to arm, forearm and hand surgeries were randomized into three groups, group A received 30 ml of plain bupivacaine 0.5% plus 2 ml of normal saline, group B received 30 ml of bupivacaine 0.5% plus 2 ml verapamil equivalent to 5 mg, group C received 30 ml of bupivacaine 0.5% plus 10 mg of nalbuphine diluted in 2 ml of normal saline. Results Results of this study showed that group C and group B sensory block time onset was 7.25 ± 1.5 vs. 10.92 ± 3.84 min, P < 0.001 and was shorter than that in group A (13.2 ± 2.66 min). In addition, the motor block onset was (11.10 ± 1.24 vs. 13.50 ± 3.77 min, P < 0.001) shorter than group A (17.16 ± 1.30 min). In group C and group B, sensory block duration was 396 ± 32.17 vs. 355.83 ± 18.48 min, P < 0.001, respectively and was longer than that in group A (321.13 ± 25.08 min). Also, there was prolonged motor block duration in group C and group B recording (338.92 ± 25.2 vs. 302.93 ± 15.24 min, P < 0.001) and was longer than that in group A (280.70 ± 32.35 min). Time of demand of rescue analgesia dose was significantly long in group C and group B (449.53 ± 52.45 vs. 418.13 ± 41.12 min, P < 0.001) and was longer than group A (361.31 ± 21.42 min). Both verapamil and nalbuphine have additive effect to bupivacaine improving the all anesthetic parameters of the block. Conclusion Both drugs produce favorable enhancement of time onset and effective prolongation of duration of sensory and motor blockade and extend the period of postoperative analgesia with superiority to nalbuphine over verapamil.

A timely and adequate response to stress is inherently present in each cell and is important for maintaining the proper functioning of the cell in changing intracellular and extracellular environments. Disruptions in the functioning or coordination of defense mechanisms against cellular stress can reduce the tolerance of cells to stress and lead to the development of various pathologies. Aging also reduces the effectiveness of these defense mechanisms and results in the accumulation of cellular lesions leading to senescence or death of the cells. Endothelial cells and cardiomyocytes are particularly exposed to changing environments. Pathologies related to metabolism and dynamics of caloric intake, hemodynamics, and oxygenation, such as diabetes, hypertension, and atherosclerosis, can overwhelm endothelial cells and cardiomyocytes with cellular stress to produce cardiovascular disease. The ability to cope with stress depends on the expression of endogenous stress-inducible molecules. Sestrin2 (SESN2) is an evolutionary conserved stress-inducible cytoprotective protein whose expression is increased in response to and defend against different types of cellular stress. SESN2 fights back the stress by increasing the supply of antioxidants, temporarily holding the stressful anabolic reactions, and increasing autophagy while maintaining the growth factor and insulin signaling. If the stress and the damage are beyond repair, SESN2 can serve as a safety valve to signal apoptosis. The expression of SESN2 decreases with age and its levels are associated with cardiovascular disease and many age-related pathologies. Maintaining sufficient levels or activity of SESN2 can in principle prevent the cardiovascular system from aging and disease.

Objectives: Tumor mutation burden (TMB) is an emerging predictive cancer biomarker. Few studies have addressed the prognostic role of TMB in non-small cell lung carcinoma, with conflicting results. Moreover, the association of TMB with different histological subtypes of lung adenocarcinoma has hitherto not been systematically evaluated. Here we studied the prognostic value of TMB and its distribution in different histological subtypes of lung adenocarcinomas in a retrospective cohort using the most recent updated classification guidelines. Materials and methods: 176 surgically resected stage I–IV lung adenocarcinomas were histologically reclassified according to WHO 2015 guidelines. A modified classification subdividing the acinar subtype into classic acinar, complex glandular and cribriform subtypes was further applied and potentially prognostic histopathological characteristics such as tumor-infiltrating lymphocytes were evaluated. 148 patients with stage I–III tumors and complete follow-up data were included in the survival analyses. TMB was determined by a commercial next generation sequencing panel from 131 tumors, out of which 105 had survival data available. Results: Predominant micropapillary, solid and complex glandular as well as nonpredominant cribriform histological subtypes were associated with significantly shorter survival. High TMB concentrated in micropapillary, solid and acinar predominant subtypes. Interestingly, TMB ≥ 14 mutations/MB conferred a stage- and histology-independent survival benefit compared to TMB

Abstract Background Development of esophageal varices (EVs) is the main complication of portal hypertension. Early detection prevents variceal bleeding. Baveno VI consensus recommended endoscopy if transient elastography (TE) > 20 kPa and platelets below 150,000/mm3. Aim Assessment of the reliability of the albumin-bilirubin (ALBI), platelets-albumin-bilirubin (PALBI), albumin-bilirubin-platelets (ALBI-PLT) score, and gamma-glutamyl transferase-platelets (GAR) ratio as non-invasive models for prediction of EVs presence and the need for endoscopy in patients with HCV-related cirrhosis. Methods HCV-related F4 fibrosis by TE or cirrhosis patients were included (n = 661). Full metabolic profile, CBC, ultrasonography, and endoscopy were done. Results The average age was 42.89 years mainly males. Patients with EVs had statistically significant (p < 0.05) higher TE values, ALBI, ALBI-PLT, and PALBI than those without EVs. Both groups were comparable for GAR. Large varices were statistically (p < 0.05) associated with higher ALBI, ALBI-PLT, and PALBI. Both small and large varices had comparable TE and GAR. EVs detection cutoffs (sensitivity, specificity): TE > 20 kPa (83.64%, 91.62%), ALBI >− 2.43 (81.28%, 74.89%), ALBI-PLT > 3 (77.34%, 72.93%), and PALBI >− 2.28 (62.1%, 76.4%). On comparison of the ROCs, TE was better than ALBI (p < 0.05), ALBI-PLT, and PALBI. ALBI was better than ALBI-PLT and PALBI. Both ALBI-PLT and PALBI are comparable (p > 0.05). Positive indirect hemagglutination of schistosomiasis, portal vein diameter, splenic vein diameter, TE, ALBI, ALBI-PLT, and PALBI were independent predictors of EVs existence. On multivariate analysis, portal vein diameter, TE, and ALBI score were significant. Conclusion The ALBI, ALBI-PLT, and PALBI are useful predictors of EVs presence and the need of diagnostic endoscopy especially in centers that lack FibroScan.

Background. Persistent orthostatic hypotension (OH) is a lesser-known complication of lung transplantation (LTx). In this retrospective case series, we describe the clinical manifestations, complications, and treatment of persistent OH in 13 LTx recipients. Methods. We identified LTx recipients who underwent transplantation between March 1, 2018, and March 31, 2020, with persistent symptomatic OH and retrospectively queried the records for clinical information. Results. Thirteen patients were included in the analysis, 9 (69%) had underlying pulmonary fibrosis, and 12 (92%) were male. The median age, height, and body mass index at LTx were 68 years, 70 inches, and 27 kg/m2, respectively. Six (46%) patients were deceased at the time of chart abstraction with a median (IQR) posttransplant survival of 12.6 months (6, 21); the 7 remaining living patients were a median of 19.6 months (18, 32) posttransplant. Signs and symptoms of OH developed a median of 60 (7, 75) days after transplant. Patients were treated with pharmacological agents and underwent extensive physical therapy. Most patients required inpatient rehabilitation (n = 10, 77%), and patients commonly developed comorbid conditions including weight loss, renal insufficiency with eGFR

(1) Background: Body mass index (BMI) was observed to affect COVID-19 outcomes; however, the complete spectrum of clinical outcomes concerning BMI remains unexplored. The current study aimed to investigate the correlation between BMI and the severity and mortality of COVID-19, as well as ICU admission, radiological findings, clinical presentation, and time to viral clearance. (2) Methods: This retrospective study included 1796 multiethnic patients with COVID-19 treated at NMC Royal Hospital, Abu Dhabi, UAE. (3) Results: COVID-19’s adjusted odds of severity increased by 3.7- and 21.5-fold in classes I and III, respectively (p = 0.001). The odds of mortality were not significantly different after adjustment for age, sex, and race. The adjusted odds of ICU admission increased significantly by 3-fold and non-significantly by 4-fold in obesity classes I and II, respectively. Pneumonia was significantly higher in patients who were overweight and class I, II, and III obese. Furthermore, class III obese patients had a greater risk of presenting with combined respiratory and gastrointestinal manifestations (p < 0.001). The median time to viral clearance with a BMI > 40 kg/m2 was moderately higher than that with a BMI < 40 kg/m2. (4) Conclusions: High BMI was associated with pneumonia, ICU admission, severity, and mortality due to COVID-19.

Introduction: Traumatic anterior shoulder instability is a rare occurrence in the childhood. While glenoid labrum articular disruption itself is an uncommon condition that accompanies shoulder instability in the contact athletes, the occurrence of such lesion in a child is of extreme rarity. To the best of our knowledge, this case is the first to be reported at such a young age. Case presentation: A six-year-old female child is presented to the clinic with a painful left shoulder and limited range of motion after a fall which was abruptly prevented by the father; hence, the child was grabbed by the arm, leaving the body to pivot around the shoulder at full force in an abduction external rotation position. Radiological studies revealed anteroinferior osteochondral fragment and a matching glenoid defect. Open surgery was performed, and the osteochondral fragment with the attached labrum was fixed using smooth K-wires. Conclusions: Although rare, shear fractures of the anterior glenoid associated with chondral damage are possible in early childhood. However, it demands a forceful burst of abduction external rotation force which could have been avoided if the child was left to fall. The use of two K-wires via an open deltopectoral approach achieved excellent results with minimum cartilage damage.

Abstract Purpose Post-traumatic arthritis is one of the leading causes of joint disability. This study aims at outlining outcomes of total knee arthroplasty in post-traumatic arthritis and technical difficulty and reviewing literature regarding this issue Patients and methods We analyzed the outcome of total knee arthroplasty following post-traumatic arthritis in 15 patients with unilateral involvement. Ten had stable arthritic knees treated with posterior stabilized (PS) prosthesis, while five with unstable arthritic knees treated as follows: three with ligamentous instability managed by constrained condylar prosthesis and two with osseous deficiency, metal augmentation used together with stemmed constrained condylar prosthesis (CCK). Average follow-up 6 years, mean age 49.8 years at time of arthroplasty. Patient outcomes were evaluated on the basis of Knee Society score. Results Mean clinical knee society scores (CKSS) at latest follow-up improved from 43.6 ± 11.66 points to 77.3± points postoperatively while mean functional knee society score (FKSS) improved from 40. ± 6.3 to 76.6 ± 84 postoperatively. Patients with stable knees had a higher mean values, both clinical and functional KSS, while unstable knees were poorer. Complications occurred in three cases, one with wound dehiscence with prolonged drainage treated by antibiotics and daily dressings until the wound closed completely, one was complicated by infection and improved by serial debridement, and the third case had aseptic loosening which required revision surgery. Conclusion Total knee arthroplasty for post-traumatic arthritis decreases pain and improves knee function. However; the procedure is not as simple as primary arthroplasty as it is technically demanding and requires adequate planning.

Bronchopleural fistula (BPF) is associated with high morbidity if left untreated. Although rare, the frequency of BPF in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is becoming recognized in medical literature. We present a case of a 64-year-old male with BPF with persistent air leak due to SARS-CoV-2 pneumonia treated with Spiration Valve System endobronchial valve (EBV). An EBV was placed in the right middle lobe with successful cessation of air leak. In conclusion, the use of EBVs for BPF with persistent air leaks in SARS-CoV-2 patients who are poor surgical candidates is effective and safe.

Chylothorax is an infrequent type of pleural effusion, typically exudative, caused by obstruction or laceration of the thoracic duct by malignancy, trauma, or thoracic surgery. Transudative chylous pleural effusions are extremely rare. We report a case of a 63-year-old male with recurrent transudative chylothorax secondary to cirrhosis that completely resolved with transjugular intrahepatic portosystemic shunting (TIPS). Transudative chylous pleural effusion is an extremely rare entity with only a few cases reported in the literature to date. Transudative chylothorax can occur in patients with liver cirrhosis. Recognizing this association will prevent unnecessary testing and procedures. Timely diagnosis and early initiation of treatment are pivotal in preventing complications from malnutrition and infection by preventing loss of electrolytes, immunoglobulins, and T-lymphocytes.

By fusing the Lindley and Lomax distributions, we present a unique three-parameter continuous model titled the minimum Lindley Lomax distribution. The quantile function, ordinary and incomplete moments, moment generating function, Lorenz and Bonferroni curves, order statistics, Rényi entropy, stress strength model, and stochastic sequencing are all carefully examined as basic statistical aspects of the new distribution. The characterizations of the new model are investigated. The proposed distribution’s parameters were evaluated using the maximum likelihood procedures. The stability of the parameter estimations is explored using a Monte Carlo simulation. Two applications are used to objectively assess the new model’s extensibility.

In August 2016, tomato plants grown during a hot, wet summer with heavy soil flooding, displaying symptoms of wilting, dead plant, root rot with crown and stem rot, at Beni Suef and Fayoum governorates were examined. A number of 16 fungal isolates were isolated from tomato plants displaying the above symptoms. These isolates were classified as belonging to six species, namely: Alternaria solani, Chaetomium globosum, Fusarium solani, Fusarium oxysporum, Pythium spp. and Rhizoctonia solani. Isolates of Pythium spp. were prevalent and were found to be more pathogenic than the other fungal isolates. This species causes damping-off, root rot, sudden death, stem rot and fruit rot. The pathogen was identified as Pythium aphanidermatum based on morphological, cultural, and molecular characteristics. Biogenic silver nanoparticles (AgNPs) were produced using the F. oxysporum strain and characterized by transmission electron microscopy (TEM). The size of these spherical particles ranged from 10 to 30 nm. In vitro, biogenic AgNPs showed antifungal activity against P. aphanidermatum. In greenhouse and field experiments, AgNPs treatment significantly reduced the incidence of dead tomato plants due to root rot caused by P. aphanidermatum compared to the control. All of the investigated treatments were effective and the treatment of root dipping plus soil drenching was the most effective. To the best of our knowledge, this study describes P. aphanidermatum on tomato in Egypt for the first time. Also, biogenic AgNPs could be used for controlling root rot disease caused by this pathogen.

Objective: To compare the use of rocuronium with that of dexmedetomidine as an adjuvant to the local anesthetic mixture in peribulbar anesthesia for cataract surgery. Design: A double blind, prospective, randomized controlled study. Methods: Ninety patients with cataract in the age group 18–80 years of American Society of Anesthesiologists (ASA) physical status I–III scheduled for elective cataract surgery under regional anesthesia were randomly divided into three groups; Group C (control) received peribulbar anesthesia using a mixture of 4 ml lidocaine 2%, 4 ml bupivacaine 0.5%, and 1 ml normal saline. Group R received a mixture of 4 ml lidocaine 2%, 4 ml bupivacaine 0.5%, and 0.06 mg/kg rocuronium (maximum 5 mg) in 1 ml saline. Group D received a mixture of 4 ml lidocaine 2%, 4 ml bupivacaine 0.5%, and dexmedetomidine 50 μg (1 ml). Patients were assessed for onset and duration of corneal anesthesia and globe akinesia, postoperative pain using visual analog score (VAS), intraocular pressure (IOP), and sedation level using modified Ramsay sedation score (RSS). Patient and surgeon satisfaction score were also assessed. Results: Corneal anesthesia was achieved more rapidly in groups D and R than group C (P

Cancer is the second leading cause of death world-wide. One of the most important medical practices of the 21st century is the chemoprevention of cancer. For a long history, it has been accepted that plants could prevent and exert suitable anti-carcinogenic effects for multiple types of cancers. Seriphidium herba-alba family Asteraceae has been used in the folk medicine by many cultures for treatment of various ailments since ancient times. In the current research we were aimed to evaluate the cancer chemopreventive activity of two crude extracts of S. herba-alba, methylene chloride extract and methanol extract on two cell lines: Human breast cancer cells (MCF-7) and human hepatocellular carcinoma cells (Hep-G2). Assessment of cytotoxicity using methyl thiazole tetrazolium (MTT assay) indicated that both extracts exhibit poor cytotoxicity with half maximal inhibitory concentration (IC50) >20 µg/mL. Assessment of glutathione-S-transferases (GSTs) activity (spectrophotometrically) showed statistically significant enhancement of enzyme activity after treatment with three different doses of methylene chloride extract and glutathione (GSH) concentrations were decreased. Analysis of cell mode of death by Ethidium bromide/Acridine orange (EB/AO) staining revealed that the dominant mode of death in MCF-7 cells was apoptosis. Assessment of vascular endothelial growth factor (VEGF) and platelets derived growth factor (PDGFBB) using ELISA showed that VEGF and PDGFBB levels were statistically significant decreased. In Conclusion: both extracts may be cancer chemopreventive agents since they had tumor anti-initiating, and anti-promoting activity.

Human papillomavirus is detected in over 50% of oropharyngeal squamous cell carcinomas. Human papillomavirus–positive oropharyngeal squamous cell carcinomas differ from human papillomavirus–negative tumors, and both expression patterns are classified as distinct entities. The Bmi-1 oncogene is a well-known member of the mammalian polycomb-group family. HESC5:3 and HES77 are newly developed monoclonal antibodies produced against undifferentiated embryonic stem cells. Our aim was to explore their roles in both human papillomavirus–positive and –negative oropharyngeal squamous cell carcinomas. Our cohort comprised 202 consecutive oropharyngeal squamous cell carcinoma patients diagnosed and treated with curative intent. We used tissue microarray tumor blocks to study the immunohistochemical expression of Bmi-1, HESC5:3, and HES77. We compared the expressions of these stem cell markers with p16 immunoexpression and human papillomavirus status, as well as with other characteristics of the tumor, and with patients’ clinical data and follow-up data. Human papillomavirus– and p16-positive tumors expressed less Bmi-1 and more HESC5:3 than the negative tumors. HES77 expression was high in human papillomavirus–positive oropharyngeal squamous cell carcinoma, but it did not correlate with p16 positivity. In our multivariable model, Bmi-1 and HESC5:3 were still associated with human papillomavirus, but the association between human papillomavirus and HES77 remained absent. In conclusion, Bmi-1, HESC5:3, and HES77 may have a different role in human papillomavirus–positive and human papillomavirus–negative tumors. There was no correlation between Bmi-1, HESC5:3, and HES77 expression and survival.

Most nitrates which circulate in the plasma become concentrated in salivary glands and release into saliva. Nitrate molecules are reduced to nitrites via oral facultative anaerobic bacteria. After swallowing, some nitrites are absorbed into the circulating blood and represent one of the sources of vasodilatory Nitric Oxide (NO). It has been recently found that the antiseptic mouth rinse used by healthy individuals for more than one week elevates the blood pressure to some extent and reduces nitrate reduction. In the present review, we discuss the disruption of the nitrate-nitrite-NO pathway after using the antibacterial mouthwashes. Reduction of commensal bacteria by antiseptics prevent endogenously produced nitrates from being recycled to systemic nitrite which has the potential to decrease blood pressure. Thus, it can be concluded that excessive use of oral antiseptic mouthrinses could lead to cardiovascular events particularly in patients with high risk to cardiovascular accidents.

Background: Following strabismus surgery under sevoflurane anesthesia children often experience emergence agitation (EA) and postoperative vomiting (POV). This study compared the effects of premedication with intranasal dexmedetomidine, midazolam, and placebo on postoperative EA and POV. Methods: 105 children (aged 1–7 years) undergoing elective strabismus surgery under sevoflurane anesthesia were randomly assigned to one of three groups (n = 35 each). Preoperatively, group D received intranasal (IN) dexmedetomidine (1 μg/kg), group M received IN midazolam (0.1 mg/kg), and group C received (1 ml) IN normal saline. Agitation scores (Pediatric Anesthesia Emergence Delirium [PAED] scale) and POV were assessed in post-anesthesia care unit (PACU). The incidence of intraoperative Oculocardiac Reflex OCR events, Time to spontaneous eye opening, Postoperative pain score, total consumption of rescue analgesia and time to discharge from PACU were also assessed. Results: 98 children completed the study. Incidence of agitation (defined as PAED score ⩾ 10) was significantly higher in the control group and the midazolam group than in the dexmedetomidine group (P = 0.014), and the number of patients who developed severe agitation requiring fentanyl (PAED score ⩾ 15) was also higher in the control group (P = 0.042). There was no significant difference between the incidence of POV in the PACU between the control group (28%) and the midazolam group (21%); however, the incidence was significantly lower in the dexmedetomidine group (15%). The number of intraoperative OCR events was significantly higher in the control group (39%) than in the dexmedetomidine (0%; P = 0.006) and in the midazolam group the incidence was higher than the dexmedetomidine (9%; 3 events) but did not reach statistical significance. Conclusion: Administration of intranasal dexmedetomidine to children undergoing strabismus surgery under sevoflurane anesthesia resulted in a reduced incidence of EA compared with intranasal midazolam or placebo. The incidence of POV and intraoperative OCR was also significantly lower with dexmedetomidine.

Aim: To evaluate levels of leptin and insulin in cases of unexplained early RPL in comparison with cases of previous normal pregnancies and suggest these levels as prognostic factors for the continuation of pregnancy beyond the 20th week. Methods: A prospective comparative controlled study was conducted at Obstetrics unit of Tanta University Hospital from Jan to Aug 2014 on 50 pregnant women who were divided into two groups: the study group included 25 cases with history of early RPL, and the control group included 25 cases with previous normal pregnancies. Serum levels of leptin and insulin were measured twice in both groups; at 5–8th and 10–12th week. Results: Leptin levels in ng/ml in the first sample were 9.414 ± 3.183 and 30.559 ± 10.672 in the control and study groups respectively with significant difference. As for the second sample, it was 11.672 ± 2.611 and 29.733 ± 9.133 in the control and study groups respectively with significant difference. Insulin levels in μlU/ml in the first sample were 18.075 ± 5.845 and 32.502 ± 13.057 in the control and study groups respectively with significant difference. In the second sample, on the other hand, it was 20.237 ± 4.944 and 34.128 ± 12.677 in the control and study groups respectively with significant difference. Leptin showed higher accuracy than insulin in prediction of early pregnancy loss. Conclusion: Higher levels of leptin and insulin were found in cases with early RPL especially in the aborted cases. The two hormones could be used as predictors of pregnancy continuation in these cases.

Abstract Background Factor X deficiency (also known as Stuart–Prower factor deficiency) is an autosomal recessive extremely rare hereditary hematologic disorder, affecting around 1:1,000,000 of the general population. Case Presentation This case report describes a patient with hypoplastic left heart syndrome and severe factor X deficiency, who underwent staged surgical palliation. From stage 1 Norwood palliation, through superior cavopulmonary anastomosis and ending with total cavopulmonary connection with satisfactory hemostasis and no significant perioperative bleeding complication. Conclusion The need to maintain hemostasis while aiming to prevent intracardiac thrombosis requires multidisciplinary team approach including hematologist, cardiac surgeon, pediatric cardiac intensivist, and anesthesiologist along with meticulous hemostasis during surgery and careful monitoring of coagulation profile in the postoperative period.

Aim: To clarify the value of dobutamine stress tissue Doppler in the evaluation of LV functional improvement after elective PCI. Methods: The study included 60 patients with hibernating viable myocardium proved by DSE referred for an evaluation of myocardial viability prior to revascularization. Hemodynamic and echocardiographic variables (LVEF, WMSI and TDI Sm) were assessed at rest and during stress. 1 month after PCI follow up echocardiography and TDI were done. Patients were divided into 2 groups: (Group I): 18 patients (30%) with no global functional recovery and (Group II): 42 patients (70%) with global functional recovery. Results: SBP, DPB, HR, EF, WMSI and (Sm) increased significantly at stress P = 0.001. After 1 month patients were divided into 2 groups according to functional recovery. There were no statistically significant differences between two groups neither as regards age, sex, risk factors (P > 0.05) nor as regards SBP, DBP, HR, rate/pressure product, EF and WMSI during stress but Sm increased during stress and after1 month follow up in Group II (P = 0.001). Univariate regression showed that (Sm) is the only predictor for global functional recovery. ROC curve statistical analysis shows that (Sm) is more sensitive and accurate than (WMSI) in the detection of viable myocardium which predicts improvement after revascularization (sensitivity 100%, 50% and accuracy 93.3%, 83.3% respectively). Conclusion: Stress TDI provides a feasible and quantitative technique that improves reproducibility of DSE. Sm during stress showed better accuracy than WMSI for the prediction of functional recovery following revascularization and was simple, sensitive and accurate for the detection of subtle myocardial systolic velocity changes.