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Purpose: The purpose of this study is to investigate the effectiveness of Hyperpolarized Light on lower limb cellulitis with lymphatic disorders. Methods: Thirty patients with lower limb cellulitis with lymphatic disorders participated in the study and were divided randomly into two equal groups. Group (A) received Hyperpolarized Light and Traditional Skin Care; Group (B) received Traditional skin care only. Both groups were assessed before and after treatment by using ALT 70 diagnostic model. Results: Statistical tests for normality revealed that most of variables were non-normally distributed. So, nonparametric tests were used for within group differences (Wilcoxon Signed Rank Test) and between groups differences (Mann-Whitney U Test). Statistical test used revealed that there was statistically significant difference between groups with significant reduction in ALT posttest in favor of study group A or study group (P-value0.05). So, patients participated in the two groups were homogenous.

Plastic bronchitis is a rare condition characterized by the formation of airway casts occluding the lower respiratory tract. It is described more commonly in children, especially following correction of congenital heart disease. It involves lymphatic abnormalities leading to endobronchial lymph precipitating airway cast formation. When it presents acutely, it can lead to acute airway obstruction, which can be life-threatening. Plastic bronchitis has been rarely described in adults and is potentially underdiagnosed. The purpose of this case report is to emphasize, for the adult anesthesiologist and adult critical care physician, the importance of prompt diagnosis and respiratory support in a case of plastic bronchitis.A 40-yr-old female with severe aortic stenosis underwent a Ross procedure. The surgery was uneventful, but within two hours of arrival in the intensive care unit, the patient developed severe hypoxemia. Despite attempts to optimize her respiratory status, the patient remained severely hypoxemic, and veno-venous extracorporeal membrane oxygenation (ECMO) was initiated using a percutaneous femoro-femoral cannulation. A bronchoscopy showed bronchial secretions casting the proximal bronchus, suggestive of plastic bronchitis. After numerous bronchoscopies, we were able to clean the airways and wean the ECMO support on postoperative day 3.Plastic bronchitis can present in adult patients and be life-threatening when associated with acute respiratory failure. We report an unusual case of an adult patient treated with veno-venous ECMO for plastic bronchitis following cardiac surgery. Use of ECMO support while providing airway cleaning can be lifesaving in patients with respiratory failure secondary to plastic bronchitis.RéSUMé: OBJECTIF: La bronchite plastique est une affection rare caractérisée par la formation de bouchons muqueux qui moulent et obstruent les voies aériennes inférieures. Elle est plus fréquemment décrite chez les enfants, en particulier après la correction d’une cardiopathie congénitale. Elle découle d’anomalies lymphatiques conduisant à l’accumulation de lymphe endobronchique, précipitant la formation de bouchons muqueux dans les voies aériennes. Lorsqu’elle se présente de manière aiguë, la bronchite plastique peut entraîner une obstruction aiguë des voies aériennes, une complication potentiellement fatale. La bronchite plastique a rarement été décrite chez l’adulte et est potentiellement sous-diagnostiquée. L’objectif de cette présentation de cas est de souligner, pour l’anesthésiologiste et l’intensiviste s’occupant d’une population adulte, l’importance d’un diagnostic rapide et d’un support respiratoire en cas de bronchite plastique. CARACTéRISTIQUES CLINIQUES: Une femme de 40 ans souffrant d’une sténose aortique sévère a bénéficié d’une procédure de Ross. La chirurgie s’est déroulée sans incident, mais dans les deux heures suivant son arrivée à l’unité de soins intensifs, la patiente a présenté une hypoxémie sévère. Malgré les tentatives d’optimisation de son état respiratoire, la patiente est restée gravement hypoxémique et une oxygénation par membrane extracorporelle (ECMO) veino-veineuse a été amorcée à l’aide d’une canulation fémoro-fémorale percutanée. Une bronchoscopie a montré des sécrétions bronchiques moulant les bronches proximales, évoquant une bronchite plastique. Après de nombreuses bronchoscopies, nous avons pu nettoyer les voies aériennes et sevrer la patiente du soutien ECMO au 3ème jour postopératoire. CONCLUSION: La bronchite plastique peut se présenter chez les patients adultes et être potentiellement fatale lorsqu’elle est associée à une insuffisance respiratoire aiguë. Nous rapportons un cas inhabituel d’une patiente adulte traitée par ECMO veino-veineuse pour une bronchite plastique après une chirurgie cardiaque. L’utilisation du soutien par ECMO simultanément au nettoyage des voies aériennes peut être nécessaire chez les patients atteints d’insuffisance respiratoire secondaire à une bronchite plastique.

Handicrafts is still remained as a witness to the heritage of the country and the identity of the people یthe visual memory of the Egyptian people has been consisted from its heritage arts and its skilled makers. Throughout the history, Egypt has been renowned through its heritage arts and its skilled makers who have been creative in many fields یThe preservation of Egyptian heritage and craft from extinction and introduce Egypt to the whole world through the traditional crafts that characterize the different Egyptian provinces One of the main Goals of the strategy to supporting and welfare heritage crafts As an important part of the component of the cultural identity of the Egyptian character. The problem was the new urban communities that the state was currently interested in to developing slums as Pashayer Elkhair project which needs professional development and culture development as well as spatial development ی establishment of the heritage centers that Achieves the promotion of the crafts and handicrafts for the people of these regions, will makes use their human potential to produce creation and spread culture awareness. Handicrafts suffering from poor planning and marketing strategies as a result of intense competition ی which needs to provide creativity and innovation capabilities during specialized training workshops in each craft The research seeks to have designers leading the creativity process within these center, the exhibits which attached to the heritage center stimulate the movement of sales and purchases and the tourist attraction and ease access of these industries outside Egypt. Through the Scientific Analytical Approach and the Study of the interior design of the Heritage Centre and exhibition by using digital abstract we can Advancement Handicrafts Search can reach to the impediments that facing handicrafts and highlight the important role that the heritage centers play in reviving crafts and handicrafts. And take advantage of the wasted human potential of the residents of Bashayer Elkhair projectsی and creating a link between Craftsmen and consumers through exhibition that attached to the canters.

Background: Hepatitis C virus core antigen (HCV-cAg) assay has been proposed as a more economical alternative to HCV RNA detection. Aim of the work: To evaluate the clinical utility of ELISA for HCV-cAg quantification in diagnosis and monitoring treatment outcomes in patients treated with direct acting antivirals (DAAs) for chronic hepatitis C. Patients and Methods: A prospective study on 40 subjects recruited from hepatology department and outpatient clinic in Ain Shams University Hospitals. Group I included 20 patients with positive anti-HCV antibody. Group II included 20 healthy subjects. The patient group received a combination of sofosbuvir 400 mg and daclatasvir 60 mg once daily for 12 weeks. The levels for both HCV-cAg and HCV RNA were evaluated at baseline and 12 weeks after completion of therapy. Results: Baseline HCV-cAg levels showed good correlation with HCV viral load (r=0.808, p 8 IU/ml. Conclusion: ELISA for HCV-cAg can replace the high sensitivity HCV RNA molecular assay to confirm the presence of HCV infection and to monitor treatment outcome.

Agriculture was the foundation of ancient Egypt; it helped the ancient Egyptians to turn dry lands into rich fields after the inundation of the Nile. The ancient Egyptian paid a great importance to the agriculture due to two reasons; one of them was to afford his needs from food, drink, and clothes. The second was religious purposes, as he was farming to present different kind of offerings to the deities to protect and help him. Scenes of agriculture life started to be represented for the first time during the Old Kingdom and continued during the Middle Kingdom. During the New Kingdom they began to represent some deities accompanied the agricultural scenes in order to celebrate and protect the harvest, in addition to ensure plenty and good harvest in the future. The aim of this study is to highlight the deities of agriculture whether appeared in the agriculture life scenes or not and to investigate the main roles which were played by these deities in the agriculture life especially those who appeared in its scenes and the reason of that. This study is depending on the descriptive and analytical methodology to achieve its aims. The result of this study reveals that the ancient Egyptians worshiped a huge number of Egyptian deities, but only three deities appeared accompanied the agriculture life scenes during the New Kingdom, these deities are "Amūn" king of the deities and deity of fertility in ancient Egypt, "Rennutet" deity of the harvest and "Nepri" deity of the grain. Maybe this is because of the increase of their cult especially during that time.

The combination of plant extract and antibiotic represents a template for developing of antibiofilm drugs. This study investigated the synergistic effects of pomegranate/rosemary/antibiotic combinations against antibiotic resistance and biofilm formation of Pseudomonas aeruginosa. The results showed that 17 (85%) of total P. aeruginosa isolates were biofilm producers; however, 5 (25%) isolates were demonstrated as a strong biofilm producer. The highest MIC level (1024 μg/ml) of tested antibiotics against strong biofilm producer isolates was observed with piperacillin, however the MIC ranges of ceftazidime, gentamycin, imipenem, and levofloxacin against these isolates were reached to (256–1024 μg/ml), (32–1024 μg/ml), (8–1024 μg/ml), and (8–512 μg/ml), respectively. PS-1 was the representative isolate for strong biofilm formation and high antibiotic resistance. 16S rRNA gene analysis suggested that PS-1 (accession No. MN619678) was identified as a strain of P. aeruginosa POA1. Pomegranate and rosemary extracts were the most effective extracts in biofilm inhibition, which significantly inhibited 91.93 and 90.83% of PS-1 biofilm, respectively. Notably, the synergism between both plant extracts and antibiotics has significantly reduced the MICs of used antibiotics at the level lower than the susceptibility breakpoints. Pomegranate/rosemary/antibiotic combinations achieved the highest biofilm eradication, which ranging from 90.0 to 99.6%, followed by the eradication ranges of pomegranate/rosemary combination, rosemary, and pomegranate extracts, which reached to (76.5–85.4%), (53.1–73.7%), and (41.2–71.5%), respectively. The findings suggest that pomegranate/rosemary/antibiotic combinations may be an effective therapeutic agent for antibiotic resistance and biofilm formation of P. aeruginosa.

Background: hydrocele is the most common cause of painless scrotal swelling. The incidence in adult males is approximately 1%, although prevalence varies according to country. Objective: to compare between the two groups? as regards the volume of the hydrocele sac, operative time, postoperative morbidity, length of hospital stay, and time of return to daily life. Patients and Methods: this prospective study was conducted on 40 patients with a diagnosis of unilateral (idiopathic) primary vaginal hydrocele during the period from October 2010 to October 2011. All patients were admitted to the Department of General Surgery, El-Hussein University Hospital, and underwent hydrocelectomy. Results: the age of the patients in the inguinal approach group ranged from 17 to 52 years (mean 30.75±10.67), whereas the patients included in the scrotal approach group had an age range of 16–48 years (mean 29.35±8.93). The difference in mean age between the two groups was statistically insignificant. The mean volume of the hydrocele sac was 196± 30.28 ml (range, 155–250 ml) in the inguinal approach group and 197.75±26.72 ml (range, 150–260 ml) in the scrotal approach group. The difference in mean volume of hydrocele between the two groups was statistically not significant. Conclusion: hydrocelectomy using the inguinal approach in adults is associated with low or no postoperative morbidity, no discomfort, short hospital stay, and early return to normal life. It is easily applied and allows management of any associated lesions in the inguinal canal.

Sodium N-lauroylsarcosinate (SNLS) was employed as a selective flotation collector for dolomite–apatite separation. The influence of pH, condition time, and collector dose on the flotation performance of both apatite and dolomite minerals was investigated using single mineral and binary mixed mineral flotation experiments. The performance of SNLS was compared to sodium oleate (NaOL), as a standard collector. In this study, the adsorption mechanism of SNLS on both minerals was studied using zeta-potential and FT-IR measurements. The results showed that SNLS prefers to adsorb on the dolomite mineral. The maximum difference in floatability was 83% for single dolomite and apatite minerals at pH 10 in the presence of 0.05 mmol/L SNLS. Binary mixtures of dolomite and apatite minerals of different ratios were applied, to evaluate their separation efficiency. The SNLS could separate dolomite from its mixtures with apatite minerals. Using 0.2 mmol/L of SNLS at pH 10, a concentrate of 30.9% P2O5 and 0.79% MgO was obtained from a natural phosphate ore having 25.8% P2O5 and 5.16% MgO.

Pulmonary homograft dysfunction is a limitation after the Ross procedure. Decellularized pulmonary homografts can potentially mitigate this complication. The aim of this study was to examine the incidence, predictors, progression, and morphology of pulmonary homograft dysfunction using data from the Canadian Ross Registry.From 2011 to 2019, 466 consecutive patients (mean age: 47 ± 12 years, 73% male) underwent a Ross procedure using a decellularized cryopreserved pulmonary homograft (SynerGraft SG; CryoKife, Kennesaw, Ga). Pulmonary homograft dysfunction was defined as any of the following: peak pulmonary gradient ≥30 mm Hg, pulmonary regurgitation2, or pulmonary homograft reintervention. Patients meeting ≥1 of these criteria (n = 30) were compared with the rest of the cohort (n = 436). Median follow-up is 2.2 years (maximum = 8.5 years) and 99% complete (1176 patient-years).The cumulative incidence of pulmonary homograft dysfunction was 11 ± 2% at 6 years. Pulmonary homograft stenosis was the most frequent presentation (n = 28 patients, 93%). Morphologically, stenosis occurred most often along the conduit (59%). Overall, 4 patients required homograft reintervention. At 6 years, the cumulative incidence of homograft reintervention was 3 ± 1%. The instantaneous risk was greatest in the first year after surgery (3.5%/year) and decreased to1%/year thereafter. Patient age45 years was the only independent risk factor associated with pulmonary homograft dysfunction (hazard ratio, 3.1, 95% confidence interval, 1.1-8.6, P = .03).The use of decellularized cryopreserved pulmonary homografts results in a low incidence of dysfunction and reintervention after the Ross procedure. The risk is greater in the first postoperative year. Younger age is the only independent risk factor for pulmonary homograft dysfunction.

The Ross procedure offers several advantages in nonelderly adults; however, the optimal age cutoff remains undetermined. The aim of this study was to compare the safety and mid-term outcomes after the Ross procedure in adult patients age ≤50 years and those age50 years.Between 2011 and 2019, 497 consecutive patients (mean age, 47 ± 12 years; 73% male) underwent a Ross procedure in 5 Canadian centers and were followed prospectively. Of these patients, 232 (47%) were age50 years (mean, 57 ± 4 years) and 265 (53%) were age ≤50 years (mean, 38 ± 10 years). Early and mid-term outcomes were compared between the 2 groups.Patients age50 years had more comorbidities: diabetes (14% vs 4%; P .01), chronic obstructive pulmonary disease (8% vs 2%; P .01), and coronary artery disease (17% vs 3%; P .01). In contrast, patients age ≤50 years had more redo surgeries (24% vs 8%; P .01), pure aortic regurgitation (21% vs 6%; P .01) and unicuspid valves (42% vs 9%; P .01). In-hospital mortality was similar in the 2 groups (0.4% vs 0.4%; P = .99). There were no between-group differences in perioperative complications. The cumulative incidence of reintervention was similar at 6 years (50 years: 0.7 ± 0.7%; ≤50 years: 4 ± 2%; P = .12). Survival at 6 years was 98 ± 2% in patient age50 years versus 96 ± 2% in those age ≤50 years (P = .43), similar to the age- and sex-matched general population.The Ross procedure is a safe operation in patients age50 years and provides excellent hemodynamics, stable valve function, and restored survival at mid-term follow-up. In expert centers, it should be considered as an alternative in selected patients age50 years.

In this work, erythromycin production by Saccharopolyspora erythraea NCIMB 12462 was investigated under solid state fermentation (SSF) using beet sugar root (BSR) and agro-industrial materials. Among them oat meal (OM) has given maximum yield. The combination of OM with BSR (3:3 g/flask) proved to be an efficient mixture for erythromycin production as they gave the highest erythromycin level (6531 μg/flask) when compared to BSR and peptone. Supplementation of BSR and OM mixtures with sugarcane bagasse (SCB) as inert support with different inoculum size and additional water enhanced erythromycin production with 3.1-fold higher production than BSR- OM medium. However, increasing SCB content more than 3g/flask always showed an inhibitory effect on erythromycin production. Box-Behnken response surface methodology was applied to further optimize SCB content, inoculum size and moisture level for erythromycin production. Statistical analysis of the results showed that the linear of the selected terms, their interactions and quadric terms of these three variables had significant effects. The moisture level was the key factor influencing erythromycin production, due to its largest F-value (48.01) and the lowest p-value (0.0002) among the three variables. The interactions between SCB content and moisture level had also the most significant effect (F-value = 32.51) on erythromycin production. The optimized medium produced 29884 ug/flask of erythromycin under SSF, which is 1.1% higher than the unoptimized medium.

Introduction: Malaria is among the most significant travel-related infections encountered by travelers to endemic countries in terms of morbidity and mortality. In Qatar, imported malaria has increased over the last 5 years; 493 travel-related cases were confirmed in 2016. In the current study, the knowledge of malaria chemoprophylaxis among physicians in the State of Qatar was assessed. Methods: This was a cross-sectional study conducted during a national travel health workshop at the Ministry of Public Health, Qatar. Physicians participating in the workshop from different national healthcare institutions providing travel medicine services were invited to voluntarily complete a self-administered, structured questionnaire. Results: Forty-two medical doctors participated in the study (92 response rate). Based on their specialty, almost two-thirds (64.3%) of the participants were family medicine physicians, and one-fifth (21.43%) were general practitioners. Furthermore, most of the doctors were untrained in travel medicine. The majority of participants demonstrated a good knowledge of the malaria parasite (100%), Plasmodium species (64.3%), incidence (83.3%), transmission (66.7%), and drug-resistance (95.2%) of malaria. Additionally, most physicians (>90) were knowledgeable about the major features of severe or complicated malaria as well as malaria prevention and chemoprophylaxis. Conclusion: This study highlights several areas of good knowledge on travel-related malaria prophylaxis and prevention among the study participants; however, there are still a few knowledge gaps that require mitigation. Continuing training programs on malaria prevention in travelers will sustain this good level of knowledge among physicians and improve the quality of pre-travel advice provided by travel medicine practitioners in Qatar.

The inappropriate use of antibiotics is a critical global health issue. The lack of antimicrobial stewardship exposes the community to unwarranted medication and contributes to the development of antimicrobial resistance. This study evaluated the perceptions and practice of physicians and pharmacists at primary healthcare centres of Qatar with respect to antibiotic misuse.In this cross-sectional study, we recruited 226 physicians and 82 pharmacists in primary health care centres. A multistage cluster sampling technique was used for data collection. Separate self-administered questionnaires were administered to physicians and pharmacists.Response rates for physicians and pharmacists were 97.8% and 100%, respectively. Both physicians (90.7%) and pharmacists (87.8%) perceived antibiotic misuse as a major public health issue. To prevent antibiotic misuse, most physicians and pharmacists reported a focus on patient education as well as good practices in their work.This study provides novel evidence on the perceptions and practices of health professionals concerning antibiotic prescription in primary healthcare settings of Qatar.إن الاستخدام غير الملائم للمضادات الحيوية هو قضية صحية عالمية حرجة. وعدم الإشراف على وصف المضادات الحيوية هو ممارسة تعرض المجتمع إلى استخدام أدوية لا مبرر لها، وتسهم في حدوث مقاومة لمضادات الميكروبات. تقيم هذه الدراسة إدراك وممارسة الأطباء والصيادلة في مراكز الرعاية الصحية الأولية في قطر تجاه سوء استخدام المضادات الحيوية.في هذه الدراسة المستعرضة، تطوع ٢٢٦ طبيبا و٨٢ صيدلانيا في مراكز الرعاية الصحية الأولية. جمعت البيانات باستخدام تقنية أخذ العينات العنقودية متعددة المراحل. بالإضافة إلى ذلك، تم استخدام استبانتين ذاتية مستقلة للأطباء والصيادلة على التوالي.كان معدل الاستجابة ٨.٩٧٪ و١٠٠٪ للأطباء والصيادلة على التوالي. واعتبر كل من الأطباء (٧.٩٠٪) والصيادلة (٨.٨٧٪) سوء استخدام المضادات الحيوية قضية صحية عامة رئيسة. ولمنع سوء استخدام المضادات الحيوية، ركز معظم الأطباء والصيادلة على تثقيف المرضى وكذلك الممارسة الجيدة لعملهم.قدمت هذه الدراسة أدلة جديدة عن إدراك وممارسة المهنيين الصحيين المتعلقة بوصف المضادات الحيوية في مراكز الرعاية الصحية الأولية في قطر.

Black liquor (BL) is a by-product of rice straw pulping process. It is a low costs raw material for production value-adding proteins and enzymes, which has been paid more and more attention to reduce its environmental pollution. Mixed cultures of micelial fungi, Trichoderma reesei Northern Regional Research Laboratory (NRRL)11236, Trichoderma reesei NRRL 6165 and Aspergillus niger strains NRC 5A, NRC 7A, and NRC 9A were evaluated for their ability to produce xylanase using crude hemicellulose (CHC) prepared from BL and peat moss as an inert support under solid state fermentation (SSF). The most potent strains, A. niger NRC 9A (818.26 U/g CHC) and T. reesei NRRL 6165 (100.9±57.14 U/g CHC), were used in a mixed culture to enhance xylanase production by co-culturing under SSF. In the mixed culture, xylanase production (1070.52±12.57 U/g CHC) was nearly1.3 and 10.6-fold increases over the activities attained in their monocultures, A. niger NRC 9A and T. reesei NRRL 6165, respectively. Optimization of the culture parameters of the mixed culture SSF process, concentration of ammonium sulfateand corn steep liquor, CHC/peat moss ratio, inoculum size and ratios of the two strains, initial pH value, initial moisture content and incubation time, exhibited a significant increase (2414.98± 84.02 U/g CHC) in xylanase production than before optimization.

Various parameters such as solvent selection, concentration,solid/liquid ratio, soaking time, temperature, stationary, shakingconditions, and repeated extractions were investigated in order todetermine the optimum extraction conditions of β-glucosidasefrom bagasse fermented by mixed culture of Aspergillus nigerNRC 7A and Aspergillus oryzae NRRL 447. Among varioussolvents tested, non ionic detergents gave the best results than theinorganic or organic salt solutions and distilled water. The optimumconditions for extraction of β-glucosidase were 30 min soakingtime at 40 o C under shaking condition at 150 rpm, with solid/liquidratio 1:15 (w/v), which yielded 2882.74±95.52 U/g fermentedculture (g fc) of enzyme activity. With repeated washes under theabove optimum conditions, the results showed that enzyme extractedin the 1 st and 2 nd washes represents about 90% of the total activity.Keywords Aspergillus niger · Aspergillus oryzae · β-glucosidase · extraction optimization · mixed culture · solid-state fermentationIntroductionβ-Glucosidases (β

Background Thoracic endovascular aortic repair (TEVAR) has been applied to increasingly complex aortic pathology, resulting in an increase in late complications. We characterized patients undergoing open repair after prior TEVAR including indications, operative techniques, and outcomes. Methods Chart review and query of a prospectively collected database identified 50 patients who underwent thoracic aortic operation after prior TEVAR. Active follow-up was supplemented by Social Security information for vital status. Results From July 2001 to January 2012 open arch (n = 25), descending (n = 6), thoracoabdominal (n = 17), or extra-anatomic bypass (n = 2) operations were performed after previous TEVAR (median interval from TEVAR to open surgical procedure: 13.9 months; interquartile range, 0.5 to 24 months). Indications for open operation included type 1 endoleaks (n = 19), retrograde aortic dissection (n = 9), chronic aortic dissection with persistent growth of the false lumen (n = 16), and graft infection (n = 6). Sixty percent had prior cardiovascular surgical procedures and 18% were done as emergencies. Circulatory support was required in 78% and hypothermic arrest in 48%. Hospital mortality occurred in 3 (6%) patients with no strokes and 1 patient with myocardial infarction; 5 (10%) patients required tracheostomy and 1 required dialysis. Survival was 67% at a median follow-up of 2.9 years. Conclusions Conversion to open repair after thoracic stent-grafting may be indicated for type 1 endoleak, retrograde dissection, chronic aortic dissection with persistent false lumen growth, or graft infection. These salvage operations are complex but can be completed safely with good early outcomes and preservation of the stent-graft in most cases. Late outcomes are consistent with the chronic disease state of these patients.

We describe the management of a patient with symptomatic spinal cord hypoperfusion after thoracoabdominal aortic aneurysm repair, where the neurological insult and associated emotional stress precipitated Takotsubo cardiomyopathy. Transthoracic Echocardiography showed akinetic mid and apical left ventricular segments, while basal segments were spared. Emergent coronary angiography ruled out acute coronary syndrome. Excess catecholamines have been postulated as a contributing mechanism to the disease, therefore, catecholamines were avoided to prevent further myocardial injury. Takotsubo cardiomyopathy is associated with serious morbidity and mortality, which highlights the importance of early recognition and proper management for complete recovery of both cardiac and neurologic functions.

Background Acute calculous cholecystitis is a common disease presentation in critically ill patients. It is associated with increased mortality and morbidity rates in case of insufficient treatment. However, the best approach to management is still debatable. Patients and methods This is a retrospective analysis of prospectively designed study for the evaluation of different management planes in critically ill patients presented with acute cholecystitis in a single university hospital from 2013-2017. The study included all patients with acute cholecystitis as the main reason for patient deterioration and hospital admission and also those patients already admitted in hospital ICU and consulted other departments for symptoms of acute cholecystitis. Preoperative data and operative outcomes were analyzed. Results A total of 225 patients (median age68 years; range=57–91 years) were included. Overall, 28.9% (65 patients) underwent percutaneous cholecystostomy drainage (PCD), 34.2% (77 patients) underwent open cholecystectomy (OC), and 36.9% (83 patients) underwent laparoscopic cholecystectomy. The patients’ demographics were comparable in all groups, except for age and BMI. Laparoscopic cholecystectomy was successful in 85.5% of patients. Nine patients in PCD group needed completion OC (13.8%). Preoperative comorbidities were similar in the studied groups. The postoperative infection was high in OC group (P=0.013). The overall mortality was 4%, with the highest value in the PCD group, and no significant difference was observed among all groups (0.197). Hospital and ICU stays were increased in the OC group (P=0.001). Conclusion Open and laparoscopic approaches are safe in critically ill patients and have comparable results to PCD. The advantage of disease eradication cannot be overlooked. The laparoscopic approach is better in the view of short hospital stay and infection rate.

From three commercial Friesian-Holstein dairy herds located in three different provinces of Egypt at El-Fayoum, EL-Ismailia, and EL-Beheira; a total of 183 paired serum and milk samples were collected on the same occasion and 23 Bulk Tank Milk (BTM) samples were collected for about a year. Samples were tested and evaluated to monitor the immune status of vaccinated cattle against Foot and Mouth Disease (FMD) virus (strain O1/93/ Aga / Egypt). All samples were subjected to Indirect Enzyme-linked immunosorbent assay (ELISA) test and Serum neutralization test (SNT) for the detection of specific antibodies. Although Milk is easier and more acceptable than blood sampling for surveys in many situations, results have revealed a significant correlation (r>6, P

Eleven different Aspergillus strains were evaluated for their ability to produce β-glucosidase using sugar cane bagasse as a sole carbon source under solid state fermentation (SSF). The most potent strains, A. niger NRC 7 (674.6 U/g ds) and A. oryzae NRRL 447 (83 U/g ds), were used in a mixed culture to enhance β-glucosidase production by co-culturing under SSF. In mixed culture, β-glucosidase of the two strains (814 U/g ds) was nearly 1.2- and 9.8-fold than that of monocultures of A. niger NRC 7A and A. oryzae NRRL 447, respectively. Optimization of the culture parameters, initial pH value, moisture content, inoculum size and ratios of the two strains. and incubation time exhibited a significant increase in β-glucosidase production (1,893 U/g ds) than before optimization. Single feeding with citrate-phosphate buffer, succinate buffer, casein. and soybean flour individually after the third day of the fermentation time and controlling the moisture content at 90 % (w/w) induced β-glucosidase production. Maximum enzyme production increased up to 2.1-fold compared to 2,188 U/g ds during normal batch culture. Among nitrogen sources, soybean flour gave the highest β-glucosidase (4,578 U/g ds). while urea reduced β-glucosidase production (1,693 U/g ds). However, the combination of buffers with soybean flour through two fed cycles resulted in a decrease of the enzyme than single fed with buffers or soybean flour alone.

Thirteen different Streptomyces isolates were evaluated for their ability to produce keratinase using chicken feather as a sole carbon and nitrogen sources under solid state fermentation (SSF). Streptomyces sp. NRC 13S produced the highest keratinase activity (1,792 U/g fermented substrate (fs)). The phenotypic characterization and analysis of 16S rDNA sequencing of the isolate were studied. Optimization of SSF medium for keratinase production by the local isolate, Streptomyces sp. NRC13S, was carried out using the one-variable-at-a-time and the statistical approaches. In the first optimization step, the effect of incubation period, initial moisture content, initial pH value of the fermentation medium, and supplementation of some agro-industrial by-products on keratinase production were evaluated. The strain produced about 2,310 U/gfs when it grew on chicken feather with moisture content of 75% (w/w), feather: fodder yeast ratio of 70:30 (w/w), and initial pH 7 using phosphate buffer after 8 days. Based on these results, the Box-Behnken design and response surface methodology were applied to find out the optimal conditions for the enzyme production. The corresponding maximal production of keratinase was about 2,569.38 U/gfs.

From three commercial Friesian-Holstein dairy herds located in three different provinces of Egypt "El-Fayoum, EL-Ismailia and EL-Beheira" adopted a number of different vaccination strategies, a total of 183 individual blood samples, individual pooled milk samples collected on the same occasion from the same animal and 23 Bulk Tank Milk (BTM) samples were tested and evaluated for about a year to monitor the immune status of vaccinated cattle against bovine herpesvirus 1 (BHV1) and Bovine Viral Diarrhea (BVD) viruses. All samples were subjected to "BHV1" gB monoclonal Antibody Test Kit (IBRgB test kit "IDEXX Laboratories"), indirect Enzyme-linked immunosorbent assay (ELISA) test for the detection of specific antibodies against (Abu Hammad strain) of BHV1and (Iman strain) of BVD Virus. For investigation and evaluation of vaccination program against BHV1 and BVD viruses, results revealed a high significant correlation and regression coefficient obtained between individual serum and milk titers. Individual milk and BTM samples permit an adequate determination of immune status of the herd for large scale epizotiological studies indicating if Herd Protection level (HPL) is sufficient or not. Both "Pneumo 3" (Veterinary Serum and Vaccine Research-Cairo-Egypt) and "Cattle Master 4" (Pfizer) vaccines were found to be highly effective in producing immune response against BHV1 and BVD viruses. High regression, correlation coefficient and F test significance between IBRgB blocking ELISA and BHV1 indirect ELISA in serum and milk samples were recognized.

The effects of solvent type and concentration, solid/ liquid ratio, extraction time and repeated extraction on recovery of keratinase from solid-state fermentation (SSF) of chicken feather by a local Streptomyces sp. NRC 13S were investigated in order to establish the experimental conditions for keratinase yield. Among solvents tested, 0.5% (v/v) glycerol was the best. Box- Behnken design was used to investigate the effect of relevant variables on keratinase recovery. The factors investigated were solid/liquid ratio (1:1.66-1:6.66 g/mL), glycerol concentration (0.5-5% v/v) and repeated extraction (1-5 cycle). The results showed that the maximum recovery of keratinase (6933.3 U/gfs) was obtained using 0.5 (v/v) glycerol as extracting solvent, in a solid /liquid ratio of 1:5 and three extraction cycles.

Background: The healthcare industry has focused much attention on patient satisfaction with the quality of healthcare services. However, there remains a lack of research on patient satisfaction towards the implementation of an electronic medical record system at a primary healthcare setting. This study aimed at assessing the level of patient satisfaction regarding primary health care services after the implementation of an electronic medical record (EMR) system. Methods: A descriptive cross-sectional study was conducted at the Al-Wakrah health care center, with a random/convenient sample of 52 patients attending the center. Furthermore, the investigators interviewed the participants, in the waiting area, regarding their satisfaction with the primary health care services provided following the EMR system implementation. A structured interview-based questionnaire for measuring patient satisfaction was employed. Results: The vast majority of participants indicated that the overall service at the health center greatly improved after EMR implementation. Furthermore, most interviewees were totally satisfied with the overall workflow at the health care center such as the time spent at the registration desk (76.9%), before seeing a physician (65.4%), while the physician used the computer (76.9%), physical examination (69.3%), laboratory testing (73.1%), and collecting the medication (65.4%). Regarding health education and informativeness, the participants found that labeling medication bottles was quite informative. However, less than two-thirds (61.5%) of the patients were satisfied with the health education delivered by physicians. Conclusions: The results revealed that although overall patient satisfaction was relatively high, certain aspects of the health care service remained to be a source of dissatisfaction. Thus, this study demonstrated patient acceptance and support for the electronic medical record system at the primary health care setting.

This chapter addresses Sudanese women’s contributions to the feminist religious and gender literature. It is by no means exhaustive, only an attempt to highlight some of the opportunities and obstacles that Sudanese women face in publication. A small selection is made of the areas in which Sudanese women published books or papers or other types of publications and the political economy of that activity. My intention here is to bring to light the work of Sudanese women, rather than to exclude Sudanese men and non-Sudanese scholars. Compared to the rest of the world, including some African countries, Sudanese women started researching and writing about their status fairly recently, starting in the 1940s.

Background and objectives Rice straw black liquor (RSBL) has no commercial significance and causes environmental pollution because of its poor disposal, although it holds promise as a cheap substrate for the production of β-glucosidase. The objective of the present work was to improve and optimize the cultural conditions of mixed cultures of Trichoderma reesei NRRL 6165 and Aspergillus niger NRC 9A under solid-state fermentation (SSF) for the production of β-glucosidase using crude hemicellulose (CHC) prepared from RSBL and peat moss as an inert support. Materials and methods Mixed cultures of the mycelial fungi T. reesei NRRL 11236 and T. reesei NRRL 6165 and A. niger strains (NRC 5A, NRC 7A, and NRC 9A) were evaluated for their ability to produce β-glucosidase using CHC prepared from RSBL and peat moss as an inert support under SSF. Optimization of initial pH (4-8), supplementation with different concentrations of corn steep liquor and ammonium sulfate, the initial moisture content (63.6-87.4% v/w), inoculum size and ratio of microorganisms, CHC/peat moss ratio, and incubation time (0-14 day) were studied. The extracted enzyme was assayed using p-nitrophenyl-β-d-glucopyranoside as a substrate. Data analysis was performed by one-way analysis of variance using computer software Minitab 16. Results and conclusion Mixed cultures of the mycelial fungi T. reesei NRRL 11236 and T. reesei NRRL 6165 and A. niger strains (NRC 5A, NRC 7A, and NRC 9A) were evaluated for their ability to produce β-glucosidase using CHC prepared from RSBL and peat moss as an inert support under SSF. The most potent coculture composed of A. niger NRC 9A (192.39 ± 7.37 U/g CHC) and T. reesei NRRL 6165 (12.56 ± 0.42 U/g CHC) was used in a mixed culture to enhance β-glucosidase production by coculturing under SSF. In mixed culture, β-glucosidase of the coculture (265.32 ± 0.25 U/g CHC) was nearly 1.3-fold and 10.6-fold than that of monocultures of A. niger NRC 9A and T. reesei NRRL 6165, respectively. Optimization of the environmental and culture parameters, different solid supports, concentration of nitrogen sources (ammonium sulfate and corn steep liquor), initial pH value, CHC/peat moss ratio, inoculum size and ratios of the two strains, moisture content, and incubation time exhibited a significant increase (466 ± 5.42 U/g CHC) in β-glucosidase production compared with before optimization. The study demonstrated that a substrate that does not find any commercial significance and causes environmental pollution because of its poor disposal holds promise as a cheap substrate for the production of β-glucosidase.

Background Fractures of the distal tibia can be challenging to treat because of the limited soft tissue, the subcutaneous location, and poor vascularity. Minimally invasive locked plate aims to reduce surgical soft-tissue trauma and to help preserve periosteal blood supply and fracture hematoma and is useful in treating these challenging fractures. Patients and methods This study included 26 patients between 20 and 53 years of age (mean 34 years), with both open and closed distal tibial pilon fractures that were intra-articular or extra-articular. All fractures were fixed using minimally invasive plate osteosynthesis under image control using a precontoured locking compression plate-distal tibial plate. Results There were 11 AO 43 A, seven AO 43 B, and eight AO 43 C fractures including 18 closed and eight open fractures. Fracture union was achieved in 23 patients (88%), whereas three cases (12%) showed delayed union. Four cases suffered from late infection, and plate removal was necessary, whereas six cases had minor wound problems and responded to conservative treatment. Twenty-two patients (85%) returned to their work within 1 year of operation; however, 17 patients (65%) had not returned to their preinjury sporting or leisure activities. Seven patients (27%) had angular deformities, all less than 7°. The final ankle-hindfoot score was 84.8 points. Conclusion Short-term results for treating distal tibial pilon fractures using minimally invasive locked plate (locking compression plate-distal tibial plate) to reduce surgical soft-tissue trauma and to help preserve periosteal blood supply and fracture hematoma appears encouraging, with union rates similar to that of open reduction internal fixation (ORIF) techniques, but avoiding the usual associated drawbacks.