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The production of fish waste is increasing dramatically, as more than 70% of captured fish require processing before being sold. These enormous amounts of fish by-products are mostly wasted, generating an undesirable environmental impact and a loss of value-added products. Recently, there has been a growing interest in utilizing fish scale waste as a low-cost source to produce natural nano-hydroxyapatite (HAp) ceramic growth and sustainability. On 1 April 2023, an electronic search was performed across four major databases (ScienceDirect, ProQuest, Scopus, and PubMed). Among the 1824 articles identified, only 27 met this review’s inclusion criteria. These studies not only extracted HAp from fish scales but conducted in vitro or in vivo assessments. The in vitro studies demonstrated the non-cytotoxic nature of the fish-scale derived HAp and its superior cell viability compared to control or synthetic HAp. Furthermore, histopathological evaluations revealed favorable bioavailability and biological responses. These findings indicate that HAp obtained from natural sources offers an environmentally friendly, sustainable, and cost-effective approach for manufacturing these materials and is fully utilized for commercial purposes. Such materials are promising for biomedical applications, contributing positively to the economy, environment, and overall community well-being.

Chronic obstructive pulmonary disease (COPD) and lung cancer represent formidable challenges in global health, characterized by intricate pathophysiological mechanisms and multifaceted disease progression. This comprehensive review integrates insights from diverse perspectives to elucidate the intricate roles of long non-coding RNAs (lncRNAs) in the pathogenesis of COPD and lung cancer, focusing on their diagnostic, prognostic, and therapeutic implications. In the context of COPD, dysregulated lncRNAs, such as NEAT1, TUG1, MALAT1, HOTAIR, and GAS5, emerge as pivotal regulators of genes involved in the disease pathogenesis and progression. Their identification, profiling, and correlation with the disease severity present promising avenues for prognostic and diagnostic applications, thereby shaping personalized disease interventions. These lncRNAs are also implicated in lung cancer, underscoring their multifaceted roles and therapeutic potential across both diseases. In the domain of lung cancer, lncRNAs play intricate modulatory roles in disease progression, offering avenues for innovative therapeutic approaches and prognostic indicators. LncRNA-mediated immune responses have been shown to drive lung cancer progression by modulating the tumor microenvironment, influencing immune cell infiltration, and altering cytokine production. Their dysregulation significantly contributes to tumor growth, metastasis, and chemo-resistance, thereby emphasizing their significance as therapeutic targets and prognostic markers. This review summarizes the transformative potential of lncRNA-based diagnostics and therapeutics for COPD and lung cancer, offering valuable insights into future research directions for clinical translation and therapeutic development.

Neurodegenerative diseases (NDDs), including Alzheimer’s disease (AD), Parkinson’s disease (PD), and glioblastoma tumors (GB), represent a spectrum of disorders characterized by progressive neuronal degeneration. This gradual deterioration presents significant challenges in early diagnosis and treatment. As a solution, iron oxide nanoparticles (IONPs) have emerged as promising materials due to their diminutive size and inherent biocompatibility, which facilitates bypassing the blood-brain barrier (BBB), thereby serving as effective targeted nanocarriers for neuroprotective therapeutics, offering efficient delivery to the brain. Furthermore, IONPs demonstrate efficacy as T1/T2 contrast agents (CAs), offering a novel diagnostic tool for various NDDs, emphasizing GB. Despite the expanding potential of IONPs in the management of NDDs, a clear gap exists in developing environmentally sustainable synthesis methods. Such methods must adhere to ecological standards and enable the production of nanoparticles capable of efficiently crossing the BBB. This is essential for precisely delivering and monitoring therapeutic interventions in diseases such as AD, PD, and GB. This review systematically explores the potential of green-synthesized IONPs in the context of NDD treatment. In this review, we emphasize different functionalization techniques for IONPs, tackling how these functionalized IONPs can be effective therapeutic approaches for NDDs. Moreover, we discuss biosafety and biocompatibility by covering a range of in vitro biocompatibility studies to analyze the safety of green-synthesized IONPs for the human body. Furthermore, our thorough analysis discussed the current state of green-synthesized IONPs using plant extracts polyphenols, which also act as neuroprotective agents, as proved by studies mentioned in the review.

Abstract Objective Myomectomy is the preferred surgical approach to manage uterine fibroids. However, uterine fibroids are highly vascular tumors and, consequently, extremely susceptible to problems from myomectomy-related hemorrhage. Hence, we aim to compare oxytocin efficacy and safety profile versus tranexamic acid (TA) with ethamsylate for reducing bleeding during myomectomy. Methods This randomized, double-blinded multicenter study was performed between 20th August 2020 and 20th October 2020 at El-Galaa Teaching Hospital, El Hussein University Hospital, Al-Azhar University Hospitals of Assiut, and Al-Azhar University Hospitals of Damietta. One hundred and eighty patients were enrolled and divided into three groups: group (1) received an injection of 30 IU of oxytocin in 500 ml of normal saline; group (2) received injections of 1 g of TA, 250 mg of Ethamsylate, and 110 ml of normal saline IV; and group (3) received an injection of 110 ml of normal saline IV just before surgical incision. Results In 180 premenopausal women, oxytocin and TA with ethamsylate had no significant value in lowering intraoperative blood loss compared with the placebo for abdominal myomectomy (666.25 ± 183.03, 630.72 ± 145.83, and 646.67 ± 168.92, respectively (P = 0.506)). Non-significant trends were observed for a reduction in operation time (P = 0.760), intra/postoperative blood transfusion (P = 0.624), hospital stay (P = 0.986), postoperative fever (P = 0.659), and wound infection (P = 1). Conclusion Oxytocin and TA with ethamsylate had no significant value in lowering intraoperative blood loss compared with the placebo for abdominal myomectomy which opens a new question about the role of the use of the hemostatic drug during myomectomy especially in centers with limited resources and had higher rates. Trial registration The study was registered on Pan African Clinical Trials Registry with the following number: PACTR202008739887429 and was approved on 24/08/2020.

Abstract Background Hysteroscopy is a common outpatient procedure but procedural pain limits its use. Music could be used as a pain-relieving intervention. We performed a systematic review and meta-analysis to investigate the effect of music on pain and anxiety during outpatient hysteroscopy. Methods Four electronic databases were searched: PubMed, Scopus, Web of Science, and Cochrane Library, from inception to September 2022. We included only the Randomized Controlled Trials (RCTs) that investigated the effect of music on women who underwent outpatient hysteroscopy in reducing pain and anxiety levels compared to no music. We assessed the quality of included RCTs using the risk of bias tool 1 reported in the Cochrane Handbook of Systematic Reviews of Interventions. Data were pooled as the Mean Differences (MDs) with a 95% Confidence Interval (CI) in a random-effects model, using Review Manager 5.3 software. Also, we assessed the evidence of the results using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results Three RCTs (540 women) were included. Music significantly reduced visual analogue scale (VAS) pain scores as well as State-Trait Anxiety Inventory (STAI) scores compared to controls (MD = -1.28; 95% CI [-2.19, -0.36]; P = 0.007) and (MD = -3.91; 95% CI [-6.98, -0.85]; P = 0.01) respectively. Also, the decrease in VAS score for pain was significantly greater in the music group (MD = 1.44; 95% CI [0.44, 2.45]; P = 0.005). However, the change in STAI showed no significant difference between the two groups. The GRADE ratings for all outcomes were very low. Conclusion Music is a potentially promising method for controlling pain for patients undergoing outpatient hysteroscopy; however, its effect in controlling anxiety is controversial.

Abstract Objective Cesarean Section (CS) is associated with an increased risk of hemorrhage. Many drugs are used to decrease this risk. We aim to compare the combination of ethamsylate and tranexamic acid, oxytocin, and placebo in women undergoing CS. Methods We conducted a double-blinded, randomized, placebo-controlled trial between October and December 2020 in four university hospitals in Egypt. The study included all pregnant women in labor without any complications who accepted to participate in the study between October and December 2020. The participants were divided into three groups. The subjects were randomly allocated to receive either oxytocin (30 IU in 500 ml normal saline during cesarean section), combined one gram of tranexamic acid with 250 mg of ethamsylate once before skin incision, or distilled water. Our main outcome was the amount of blood loss during the operation. The secondary outcomes were the need for blood transfusion, hemoglobin and hematocrit changes, hospital stay, operative complications, and the need for a hysterectomy. The one-way ANCOVA test was used to compare the quantitative variables between the three groups while the Chi-square test was used to compare the qualitative variables. Post hoc analysis then was performed to compare the difference between every two groups regarding the quantitative variables. Results Our study included 300 patients who were divided equally into three groups. Tranexamic acid with ethamsylate showed the least intra-operative blood loss (605.34 ± 158.8 ml) compared to oxytocin (625.26 ± 144.06) and placebo (669.73 ± 170.69), P = 0.015. In post hoc analysis, only tranexamic acid with ethamsylate was effective in decreasing the blood loss compared to placebo (P = 0.013); however, oxytocin did not reduce blood loss compared to saline (P = 0.211) nor to tranexamic acid with ethamsylate (P = 1). Other outcomes and CS complications showed no significant difference between the three groups except for post-operative thrombosis which was significantly higher in the tranexamic and ethamsylate group, P

Abstract Background Many drugs are prescribed in relieving acute migraine attacks, we aim to compare metoclopramide with other antimigraine drugs. Methods We searched online databases like PubMed, Cochrane Library, Scopus, and Web of Science till June 2022 for RCTs that compared metoclopramide alone with placebo or active drugs. The main outcomes were the mean change in headache score and complete headache relief. The secondary outcomes were the rescue medications need, side effects, nausea and recurrence rate. We qualitatively reviewed the outcomes. Then, we performed the network meta-analyses (NMAs) when it was possible. which were done by the Frequentist method using the MetaInsight online software. Results Sixteen studies were included with a total of 1934 patients: 826 received metoclopramide, 302 received placebo, and 806 received other active drugs. Metoclopramide was effective in reducing headache outcomes even for 24 h. The intravenous route was the most chosen route in the included studies and showed significant positive results regarding headache outcomes; however, the best route whether intramuscular, intravenous, or suppository was not compared in the previous studies. Also, both 10 and 20 mg doses of metoclopramide were effective in improving headache outcomes; however, there was no direct comparison between both doses and the 10 mg dose was the most frequently used dosage. In NMA of headache change after 30 min or 1 h, metoclopramide effect came after granisetron, ketorolac, chlorpromazine, and Dexketoprofen trometamol. Only granisetron’s effect was significantly higher than metoclopramide’s effect which was only significantly higher than placebo and sumatriptan. In headache-free symptoms, only prochlorperazine was non-significantly higher than metoclopramide which was higher than other medications and showed significantly higher effects only with placebo. In rescue medication, metoclopramide’s effect was only non-significantly lower than prochlorperazine and chlorpromazine while its effect was higher than other drugs and showed higher significant effects only than placebo and valproate. In the recurrence rate, studies showed no significant difference between metoclopramide and other drugs. Metoclopramide significantly decreased nausea more than the placebo. Regarding side effects, metoclopramide showed a lower incidence of mild side effects than pethidine and chlorpromazine and showed a higher incidence of mild side effects than placebo, dexamethasone, and ketorolac. The reported extrapyramidal symptoms with metoclopramide were dystonia or akathisia. Conclusion A dose of 10 mg IV Metoclopramide was effective in relieving migraine attacks with minimal side effects. Compared to other active drugs, it only showed a lower significant effect compared with granisetron regarding headache change while it showed significantly higher effects only with placebo in both rescue medication needs and headache-free symptoms and valproate in only rescue medication need. Also, it significantly decreased headache scores more than placebo and sumatriptan. However, more studies are needed to support our results.

Abstract Background: Anal fissures and hemorrhoids are common anal conditions. They cause significant morbidity, social embarrassment, and work absenteeism. In addition, they form a significant workload on the healthcare system. Nevertheless, the etiology of these conditions is still contentious. It has been observed that hemorrhoids and anal fissures are associated with prolonged sitting. This study aims to investigate this observation. Methods: This is a case–control study. We compared 81 patients with symptomatic and endoscopically proven hemorrhoids and/or anal fissures with 162 controls with no symptoms or endoscopic evidence of perianal disease. The study was conducted at Khartoum North Teaching Hospital (KNTH) endoscopy unit between January and December 2019.Demographic data, sitting hours per day, and endoscopic findings of patients and controls were recorded in a proforma. The cases and controls were matched for age, sex, and bowel habits. Data were analyzed and compared using the SPSS version 23. Results: The mean sitting hours for cases was 5.99 (SD 3.4) whereas that for controls was 4.0 (SD 3.0) with a highly significant difference (P < 0.001). Sitting for 5 hr or more per day (exposure) was associated with an increased risk of developing hemorrhoids and/or anal fissures [odds ratio 3.68, 95% CI: 2.1–6.47]. Conclusion: The study showed that sitting down for 5 hr or more per day might increase the risk of developing hemorrhoids and/or anal fissures. This finding could help in the prevention and treatment of these diseases and the reduction of recurrences.

Abstract Background Heart rate variability (HRV) is a valuable indicator of autonomic nervous system integrity and can be a prognostic tool of COVID-19 induced myocardial affection. This study aimed to compare HRV indices between patients who developed myocardial injury and those without myocardial injury in COVID-19 patients who were admitted to intensive care unit (ICU). Methods In this retrospective study, the data from 238 COVID-19 adult patients who were admitted to ICU from April 2020 to June 2021 were collected. The patients were assigned to myocardial injury and non-myocardial injury groups. The main collected data were R-R intervals, standard deviation of NN intervals (SDANN) and the root mean square of successive differences between normal heartbeats (RMSSD) that were measured daily during the first five days of ICU admission. Results The R-R intervals, the SDANN and the RMSSD were significantly shorter in the myocardial injury group than the non-myocardial group at the first, t second, third, fourth and the fifth days of ICU admission. There were no significant differences between the myocardial injury and the non-myocardial injury groups with regard the number of patients who needed mechanical ventilation, ICU length of stay and the number of ICU deaths. Conclusions From the results of this retrospective study, we concluded that the indices of HRV were greatly affected in COVID-19 patients who developed myocardial injury.

Abstract Background Repeated implantation failure (RIF) is defined as the case whereby the transferred embryos fail to implant after several attempts of In vitro fertilization (IVF) which causes a profound impact on the quality of life and financial burden. Some clinical studies have confirmed that Granulocyte colony-stimulating factor (G-CSF) and human chorionic gonadotropin (HCG) can improve pregnancy outcomes and implantation rates. Hence, our study aims to compare the efficacy of G-CSF and HCG on pregnancy outcomes in RIF women who undergo intra-cytoplasmic sperm injection (ICSI). Methods This randomized, single-blinded study was conducted et al.-Azhar University Hospitals, Cairo, Egypt, between 10th October 2020 and 20th December 2020. The study included 100 women aged 20–43 years old undergoing ICSI cycles, with a history of RIF. Patients were divided randomly into two groups: group (1): included 50 patients injected with 500 IU of intrauterine HCG on embryo transfer day, and group (2): Included 50 patients injected with G-CSF on the embryo transfer day. Results In 100 RIF women, we found a significant improvement in pregnancy outcomes favoring G-CSF over HCG including implantation rate, chemical pregnancy, and clinical pregnancy (P

Abstract Background The main purpose is to investigate the effect of LiCO3 as an add-on therapy with radioactive iodine in increasing the cure and decreasing the T4 level compared to radioactive iodine alone. The primary outcome is the cure rate as defined by the number of hyperthyroid patients who became euthyroid or hypothyroid. The secondary outcome is the T4 level. Methods Four databases were searched (PubMed, Scopus, Web of Science, and Cochrane central library). The inclusion criteria were randomized and non-randomized clinical trials of hyperthyroidism patients receiving LiCO3 with radioiodine compared with hyperthyroidism patients receiving radioactive iodine alone. Included studies were appraised with the risk of bias version 2 tool, according to the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. Results Nine studies were eligible for inclusion in the study, six randomized control trials and three non-randomized control trials. There were 477 patients in the intervention group and 451 patients in the control group. The cure rate was not significantly different between the two groups, while it was significantly increased with 5000 to 6500 mg optimized cumulative dose of LiCO3 compared with the control group, P = 0.0001. The T4 level showed no significant difference between the two groups, P = 0.13. Conclusions LiCO3 adjunct to radioactive iodine did not show significant differences compared with radioactive iodine alone in terms of cure rate or decreasing T4 level. However, the dose of 5000 to 6000 mg of LiCO3 may increase the cure rate.

Abstract The herbal products proved to be more promising antimicrobials even though their antimicrobial activity is milder than commercially available antibiotics. Moreover, herbal drugs may act synergistically with antibiotics to kill microbes. In this study, we aimed to enhance the activity of penicillin against MRSA through combination with the active saponin fraction isolated from the Zygophyllum album plant. Three different types of metabolites (saponins, sterols, and phenolics) have been extracted from Zygophyllum album with ethanol and purified using different chromatographic techniques. The antibacterial activity of crude extract and the separated metabolites were checked against MRSA isolates, Saponin fraction (ZA-S) was only the active one followed by the crude extract. Therefore, the compounds in this fraction were identified using ultra-high-performance liquid chromatography connected to quadrupole time-of-flight mass spectrometry (UHPLC/QTOF-MS) operated in positive and negative ionization modes. UHPLC/QTOF-MS revealed the presence of major six ursane-type tritepenoidal saponins (Quinovic acid, Quinovic acid 3β-O-β-D-quinovopyranoside, Zygophylloside C, Zygophylloside G, Zygophylloside K and Ursolic acid), in addition to Oleanolic acid. Interaction studies between saponin fraction and penicillin against MRSA were performed through the checkerboard method and time-kill assay. According to checkerboard results, only three combinations showed a fractional inhibitory concentration index less than 0.5 at concentrations of (62.5 + 312.5, 62.5 + 156.25, and 62.5 + 78.125 of penicillin and ZA-S, respectively). Time kill assay results showed that the highest reduction in log10 colony-forming unit (CFU)/ml of initial inoculum of MRSA after 24 h occurred by 3.7 at concentrations of 62.5 + 312.5 (µg/µg)/ml of penicillin and ZA-S, respectively. Thus, the combination between saponin fraction of Zygophyllum album and penicillin with these concentrations could be a potential agent against MRSA that can serve as possible model for new antibacterial drug.

Objective: To describe the mortality difference between acute ischemic stroke (AIS) and non-AIS groups within COVID-19 patients. Materials & methods: We included observational studies through September 2020 that categorized COVID-19 patients into two groups (with and without AIS). Results: Eight studies with a total sample size of 19,399 COVID-19 patients were included. The pooled risk difference showed that patients with COVID-19 who developed AIS had significantly higher mortality than those without AIS by a risk difference of 24% (95% CI: 0.10–0.39; p = 0.001). In two studies, the COVID-19+AIS group had significantly higher lymphocytes, procalcitonin and creatinine levels. Conclusion: Developing AIS significantly adds to the mortality of COVID-19. Timely interventions to manage those patients are strongly recommended.

Objective The adherence to public health recommendations to control COVID-19 spread is influenced by public knowledge, attitudes and practices (KAP). We performed this cross-sectional study to assess the levels and determinants of public KAP towards COVID-19 in a large, multinational sample.Design Cross-sectional study (survey).Setting The questionnaire was distributed to potential respondents via online platforms.Participants 71 890 individuals from 22 countries.Methods We formulated a four-section questionnaire in English, followed by validation and translation into seven languages. The questionnaire was distributed (May to June 2020) and each participant received a score for each KAP section.Results Overall, the participants had fair knowledge (mean score: 19.24±3.59) and attitudes (3.72±2.31) and good practices (12.12±1.83) regarding COVID-19. About 92% reported moderate to high compliance with national lockdown. However, significant gaps were observed: only 68.2% knew that infected individuals may be asymptomatic; 45.4% believed that antibiotics are an effective treatment; and 55.4% stated that a vaccine has been developed (at the time of data collection). 71.9% believed or were uncertain that COVID-19 is a global conspiracy; 36.8% and 51% were afraid of contacting doctors and Chinese people, respectively. Further, 66.4% reported the pandemic had moderate to high negative effects on their mental health. Female gender, higher education and urban residents had significantly (p≤0.001) higher knowledge and practice scores. Further, we observed significant correlations between all KAP scores.Conclusions Although the public have fair/good knowledge and practices regarding COVID-19, significant gaps should be addressed. Future awareness efforts should target less advantaged groups and future studies should develop new strategies to tackle COVID-19 negative mental health effects.

Objectives The burden of childhood obesity is clustered among children in low-socioeconomic groups. Social spending on children—public welfare expenditure on families and education—may curb childhood obesity by reducing socioeconomic disadvantages. The objective of this study was to examine the relationship between social spending on children and childhood obesity across the Organisation for Economic Cooperation and Development (OECD) countries.Design Ecological study.Setting Data on social spending on children were obtained from the OECD Social Expenditure Database and the OECD educational finance indicators dataset during 2000–2015. Data on childhood obesity were obtained from the NCD Risk Factor Collaboration database.Participants Aggregated statistics on obesity among children aged 5–19 years, estimated for OECD 35 countries based on the measured height and weight on 31.5 million children.Outcome measures Country-level prevalence of obesity among children aged 5–19 years.Results In cross-sectional analyses in 2015, social spending on children was inversely associated with the prevalence of childhood obesity after adjusting for potential confounders (the gross domestic product per capita, unemployment rate, poverty rate, percentage of children aged

In this study, effects of the collector added before grinding and after grinding on the subsequent flotation and mineral surface properties were investigated. The pH was controlled at 10 during the grinding and flotation processes opened to the atmosphere. With enough amounts of sodium butyl xanthate addition, adding the collector before grinding recovered more chalcopyrite than adding it after grinding in single mineral flotation. The Eh of each ground pulp before and after conditioning were measured and it was found that adding collector before grinding obtained higher and relatively suitable pulp potential for chalcopyrite flotation. Particle size analyses of the flotation products indicate that the different flotation recoveries occurred due to the different flotation losses in fine particles (