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Background: Vitamin D is a steroid hormone that is produced as a result of skin exposure to the sunlight. Vitamin D is essential to different organs and systems in the body as the bones, intestines, immune system, pancreas, brain, and control of cell cycle.Aim of the work: to assess the clinical relevance of vitamin D in colonic diseases (IBS and IBD) to know if there is a prevalence of vitamin D deficiency in these colonic diseases.Patients and Methods: This study was performed on 90 Egyptian patients who were classified into 3 groups; where Group 1 included 30 patients who have irritable bowel syndrome (IBS), Group 2 30 patients who have inflammatory bowel disease (IBD) whether Ulcerative Colitis (UC) or Crohn's Disease (CD) and Group 3 30 healthy personnel taken as Control group.Results: Regarding different vitamin D levels in the studied groups. In the control group, (20%) had deficient vitamin D level ( 30 ng/ml). In IBS group, (60%) had deficient vitamin D level, (26.7%) had insufficient vitamin D level, (13.3%) had optimal vitamin D level. In the UC group, (66.7%) had deficient vitamin D level, (16.7%) had insufficient vitamin D level, (16.7%) had optimal vitamin D level. In CD group, (50%) had deficient vitamin D level, (33.3%) had insufficient vitamin D level, (16.7%) had optimal vitamin D level.Conclusion: The role of vitamin D deficiency in the pathogenesis of many chronic illnesses has raised the attention recently. Our study revealed that 25-OH-D3 deficiency is found more frequently among UC, CD and IBS patients than normal healthy controls. Thus, vitamin D prescription in these patients may help in improving these colonic diseases.

Background Antibiotic resistance in Helicobacter pylori is the major cause of eradication failure. Prevalence of H.pylori antibiotic resistance is increasing worldwide, and it is the main factor affecting efficacy of current therapeutic regimens. Our aim is to investigate H.pylori resistant patients toward Levofloxacin and detect the most effective antibiotic in eradication of H.pylori. Objective To investigate H.pylori resistant patients toward Levofloxacin including regimens and to detect the most effective antibiotic in H.pylori eradication. Patients and Methods The present study aimed to investigate the Susceptibility of Levofloxacin Resistant H.pylori in patients who had been diagnosed and received any regimen including Levofloxacin and still signs and symptoms of H.pylori infection not releaved and after proper time of stoppage of PPI and antibiotics H.pylori Ag in stool still positive at the period from January 2019 to February 2020. Results In the present study we found a wide spectrum of resistance to rates of H. pylori, from nearly negligible rates of Rifampicin (0%), Imipenem (0%), Cefotaxime (2%), Tetracycline (6%), Doxycycline(10%), and Amoxicillin(38%). To high rates resistance to Metronidazole (100%), Erythromycin (72%), Clarithromycin (68%), Azithromycin (60%), Ciprofloxacin (52%), and Levofloxacin (48%). Conclusion Helicobacter pylori is the most common chronic bacterial infection in humans. Antibiotic resistance is a major issue nowadays. Prior use of macrolide antibiotics or metronidazole appears to increase the risk of H. pylori resistance. Clarithromycin resistance appears to be an "absolute" condition that can not be overcome by increasing the macrolide dose. Levofloxacin resistance seems to be increasing. Culture and susceptibility should be done before starting second line treatment.

Background Thoracolumbar spine fractures are common injuries that can result in significant disability, deformity and neurological deficit. Controversies exist regarding the appropriate radiological investigations, the indications for surgical management and the timing, approach and type of surgery. Aim of the Work to discuss: Guidelines and controversies of short versus long posterior fixation in management of thoracolumbar spine fractures. Patients and Methods 20 articles were identified through specified electronic databases. After application of the inclusion and exclusion criteria, 9 comparative studies were finally included in this systematic review. Various other approaches were used in combination with posterior pedicle screw fixation according to the underlying pathology (e.g. Discectomy, Laminectomy, Vertebroplasty, Kyphoplasty, etc.). A total of 194 patients underwent short segment pedicle screw fixation compared to 158 patients who underwent Long segment pedicle screw fixation for various indications. The majority of the included trials were small studies with between 12 and 69 participants. The patients’ characteristics were comparable within each study group. Individual patient data were available from these articles. Results A total of 194 patients underwent short segment pedicle screw fixation compared to 158 patients who underwent Long segment pedicle screw fixation for various indications. The majority of the included trials were small studies with between 12 and 69 participants. The patients’ characteristics were comparable within each study group. Individual patients data were available from these articles; longest follow up post operative record was about 71 months; 162 male and 93 female in these studies; the mean age about 38 years; the level of thoracolumbar fracture was: 60 patients at T12,104 patients at L1 and 41 patients at L2. Conclusion This review suggest work on the guidelines with evaluating of each case according to age, angels, height, weight (BMI), comorbidities, ability to anaesthesia and types of instability in the patient before as osteoporosis and kyphosis. Degree of angels of cobb and kyphotic angel which are major factors determine if posterior long or short.

Background Patients with cirrhosis are more susceptible to develop AKI than the non-cirrhotic individuals. AKI has an estimated prevalence of approximately 20% to 50% among hospitalized patients with cirrhosis. Physicians caring for patients with cirrhosis should recognize the acute or chronic character of renal disease, the causes of renal injury, the clinical conditions leading concomitantly to AKI and liver dysfunction, and the prognostic factors associated with the progression of AKI. Hypovolemia (due to diuretics, hemorrhage and diarrhea), acute tubular necrosis (ATN), sepsis, nephrotoxic agents (such as nonsteroidal anti-inflammatory drugs, aminoglycosides and/or radiological contrasts) and hepatorenal syndrome (HRS)-type 1 are the most common causes of AKI in cirrhotic patients. Objective To evaluate the sensitivity of fractional excretion of urea (FEUrea) vas a diagnostic biomarker for different causes of acute kidney injury in liver cirrhosis. Patients and Methods This study was conducted in co-operation between Tropical Medicine Department, Ain-Shams University and the Gastroenterology and Hepatology Department, Theodor Bilharz Research Institute between July 2019 to January 2020. It included 70 adult Egyptian patients admitted for treatment of complications of cirrhosis who fulfilled the eligibility criteria and compared to 10 cirrhotic patients without renal impairment. All patients were subjected to; full history taking, thorough clinical examination, laboratory investigations, Child-Pugh score was calculated for admission and urine samples were collected for urinary urea and creatinine levels to calculate FEUrea. Results Concerning the gender distribution in this study, male to female percent was 40 (57.10%) males and 30 (42.90%) females for gender, respectively. As regards to the causes of AKI, there were 24 (34.30%) PRA, 7 (10.00%) HRS and 39 (55.70%) ATN for final diagnosis. In the current study, there was significant difference (P = 0.0001; P 33%) compared to lower cut-off values for PRA (21%) and HRS ( Conclusion FEUrea was found to be an excellent simple tool for the differential diagnosis of AKI in patients with decompensated cirrhosis and ascites. FEUrea has also proven to be a useful “tubular injury” marker by differentiating ATN from non-ATN with high diagnostic accuracy (Sensitivity and Specificity exceeding >90%). FEUrea was found to be a good alternative and noninvasive tool for differentiating causes of AKI in cirrhotic patients instead of other non-available or expensive markers.

Background Hepatitis C infection is a disease with significant global impact, about 130150 million people chronically infected with the hepatitis C virus (HCV), representing about 2-2.5% of the world’s population. In Egypt, the prevalence is 10% and according to the last DHS in 2015 it was 7%. Aim of the Work to evaluate the effect of SVR using DAAs on the stage of the liver fibrosis in HCV patients by measuring of liver stiffness, using transient elastography before and after receiving treatment. Patients and Methods This study was conducted in co-operation between Gastroenterology and Hepatology Department, AinShams University and the Gastroenterology and Hepatology Department, Theodor Bilharz Research Institute between January 2019 to September 2019. It included 103 adult Egyptian patients who received SOF/DAC for three months and were assessed before and after achieving SVR-24. The patients were recruited from the outpatient clinic of Theodor Bilharz Research Institute Hospital (after consents were obtained). Results study showed that achieving SVR-24 was associated with improvement of LSM assessed by Transient Elastography and application of FIB-4 score and overall improvement of liver biochemistry as shown by reduction of AST, ALT and serum bilirubin and increase of serum albumin, INR and platelets. This was accompanied by increase of hemoglobin, Creatinine and BMI. The study also showed despite the fact that results were accompanied by significant improvement in LSM, Fib-4 and liver biochemistry, achieving SVR did not guarantee improvement of cirrhosis; only 29% of cirrhotics regressed to sub-cirrhotic range (LSM Conclusion Sofosbuvir / Daclatasvir combination is effective and well tolerated for treatment of genotype 4 chronic hepatitis C patients. Achieving SVR-24 was associated with significant improvement of LSM using transient elastography to assess liver fibrosis. Achieving SVR-24 was associated with overall improvement of liver biochemistry. Improvement of LSM was more in cirrhotic patients than non-cirrhotic patients.

Background Speech impairment occurs in 34-70% of head and neck oncologic patients. Management of this impairment is through surgical and nonsurgical methods. Progress in voice rehabilitation following total laryngectomy has over the last 30 years, made an enormous difference in the whole concept of the management of laryngeal cancers. Objective To explore the outcome of different options of voice rehabilitation after total laryngectomy and the advantages and disadvantages of each method in order to improve the quality of life of laryngectomized patients and the suggestion of future directions for research. Patients and Methods The Aim of this work is to provide cumulative data about the efficacy and safety of the outcome of different modalities of voice rehabilitation following total laryngectomy. This review was done using standard methodology outlined in the Cochrane Handbook and reported the findings in accordance with the Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) statement guidelines. Results Voice rehabilitation is one of the most important determinants of the quality of life after total laryngectomy. Recent advances in prosthetic voice devices have made such devices the gold standard for voice rehabilitation. They are thus preferred and used more often than old methods (esophageal speech and artificial larynx). Conclusion Although, no single method is considered to be the best for every patient, the tracheoesophageal puncture has become the most preferred method in the past decade. But it is not always possible in all patients, the results of this study indicate that ES, when achievable, is a viable option that should be considered by surgeons when making intervention decisions on patients, and should be revived when indicated. But we need much more studies.

The utilization of antimicrobial drugs has an important effect in chicken husbandry as they are used in prophylaxis, treatment and growth enhancement made poultry a major reservoir of antimicrobial-resistant bacteria. Therefore, our study was undertaken to isolate and control the most common bacterial contamination. For this purpose a total of seventy samples from raw chicken meat and organs (livers, hearts, spleens, muscles, kidneys, skin and gizzards) were collected from different retail markets and abattoirs in Sharkia governorate, Egypt. Nutrient agar was used for the total bacterial count (TBC) , mannitol salt agar for the total Staphylococcus count (TSC) and macConkey’s agar for the total Enterbacteriacae count (TEC). The most common bacteria were identified as Staph. aureus, E.coli and Salmonella isolates in an incidence of 8.57%, 35.7% and 4.28% respectively. The percentage of resistant bacteria to the tested antibiotic were77.8%, 85.7% and 71.4% for Staph. aureus, E.coli and Salmonella respectively. The most effective aquatic plant extract was clove followed by rosemary for its antibacterial effect. The silver nanoparticles has been synthesized and recognized by the color change and UV measurement after incubation of silver nitrate and watery extract of clove at dark conditions, it clearly showed complete inhibitory effect against all the tested MDR bacteria.

Labor unionization has no causal effect on firm risk. Using a regression discontinuity design to study the impact of labor union elections on option-implied firm risk, we find that unionization per se does not affect investor perceptions about firm price, tail, or variance risk. This finding is robust to studying very short (5-trading day) and long (up to 2-year) windows around the elections. Moreover, there is no unionization effect on firm risk either in subsets of firms facing strong union bargaining power, or with characteristics that prior literature identifies as important determinants of the effect of unionization on firm outcomes.

Monitoring by long-term investors should reduce agency conflicts in firms' labor investment choices. Consistent with this argument, we find that abnormal net hiring, measured as the absolute deviation from optimal net hiring predicted by economic fundamentals, decreases in the presence of institutional investors with longer investment horizons. Firms dominated by long-term shareholders reduce both over-investment (over-hiring and under-firing) and under-investment (under-hiring) in employees. The monitoring role of long-term investors is stronger for firms facing higher labor adjustment costs both in absolute terms and relative to capital adjustment costs, and those for which human capital is regarded as more important. The effect is also more pronounced for firms that have stronger incentives and/or more opportunities to deviate from expected net hiring. We address endogeneity concerns by exploiting exogenous changes to long-term institutional ownership resulting from annual reconstitutions of the Russell indexes.

Background hepatocellular carcinoma is the fifth most common tumor worldwide and the second most common cause of cancer-related death with a male-to-female predominance greater than 2:1. The presence of cirrhosis represents a key risk factor for the development of HCC. The prevalence of cirrhosis among patients with HCC has been estimated to be 85%-95% and the HCC incidence rate among patients with cirrhosis has been shown to be 2%-4% per year. HCV infection is a leading cause of liver cirrhosis and hence the development of HCC. Egypt has the highest HCV prevalence worldwide; with estimated rate of 10% of Egyptians between 15 – 59 years as reported by the Egyptian Health Issues Survey (EHIS) in 2015. Aim of the Work the aim of this study was to evaluate the impact of Direct Acting Antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection on recurrence of HCV related HCC after intervention. Patients and Methods this study was conducted on 50 patients with previously treated HCC who were treated for HCV infection using direct acting antiviral agents after confirming HCC regression and response to different treatment modalities and were followed for one year after antiviral treatment. A control group of another 50 patients with cured HCC who didn’t receive DAA therapy was included in the study to compare the recurrence rate in both groups and its relation to the antiviral therapy. Results the two groups didn’t differ as regards age, sex, biochemical profile, AFP, CBC and child score. The results of the study came to show an HCC recurrence rate of 38% in patients who received direct acting antiviral therapy after HCC intervention versus 62% in those who didn’t receive antiviral therapy. Conclusion direct acting antiviral drugs didn’t show to increase the risk of HCC recurrence in comparison to the control group. Yet it did not abolish it. So, close follow up of patients with HCC receiving antiviral therapy is highly recommended.

The silkworm is an important economic insect due to production of silk. It is the larva or caterpillar of the domesticated silk moth, (Bombyxmori L.) . In the rearing of silkworm bacterial flacherie considered the most important disease effect in silk production. Flacherie is a Syndrome associated with bacterial disease. In the present study the isolation of pathogenic bacteria from infected larvae . The infected larvae samples were serially diluted from which 10-5,10-6 and cultivated onto nutrient agar plate. The dominant colonies were selected identification by colony morphology, Gram staining property and biochemical test and confirmed the identification by 16SrRNA which proved the name of bacteria as Bacillus thuringensis SW2 with accession number (MK327364.1). The genus of Bacillus thuringensisSW2 was responsible of mortality in 4th and 5th instars of the larval stages of B. mori L. after 3 days recorded 4.66a and 2.66b in 4th, 5th instars respectively post infection and highest mortality rate was obtained at 5 days recorded 12a, 12.66a in 4th and 5thinstars receptively and the total injury reach to 31a,32a in 4th and 5thinstars receptively after 5days.

Firms differ in their dependence on skilled labor, and face labor adjustment costs that increase with their workers’ skill level. We show that firms with a higher share of skilled workers, and thus less flexibility to adjust their labor demand in response to cash flow shocks, hold more precautionary cash. The effect of labor skills on cash holdings is more pronounced for financially constrained firms and varies with exogenous differences in firing and hiring costs. We address endogeneity concerns by using subsamples of firms with reasonably similar characteristics, propensity score matching, and a quasi-experimental shock to labor markets.

This paper examines the relation between employee welfare practices and corporate cash holdings. We find firms that are strongly committed to employee well-being, measured by ratings on employee relations, to hold more cash. The effect of employee welfare standards on cash holdings is stronger for firms in human-capital-intensive, competitive, and high-labor-mobility industries in which employees are more important to their businesses. These results are consistent with the predictions of the stakeholder theory. Overall, our paper provides novel evidence on the role human capital and employee relations play in a firm'€™s cash management policy.

We investigate how the investment horizon of a firm’s institutional shareholders affects the efficiency of its labor investments. We argue that long-term investors have greater incentives to engage in effective monitoring, which reduces agency conflicts in labor investment choices. Consistent with this argument, we find that abnormal net hiring, measured as the absolute deviation from net hiring predicted by economic fundamentals, decreases in the presence of institutional investors with longer investment horizons. Firms dominated by long-term shareholders reduce both over-investment (over-hiring and under-firing) and under-investment in labor (under-hiring). The monitoring role of long-term investors is more pronounced for firms facing higher labor adjustment costs. These results are robust to alternative model specifications and variable definitions, as well as to tests controlling for the endogeneity in the institutional shareholders’ investment decisions. Overall, our findings suggest that institutional investors play an important role in firm-level employment decisions.