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Background: Sepsis, especially septic shock, and its complications have been linked to the hyperadrenergic stress response., Research Question: Does decatecholaminization with dexmedetomidine lower the in-hospital mortality in patients with septic shock?, Study Design and Methods: This open-label randomized controlled trial assessed the effects of a heart rate (HR)-calibrated dexmedetomidine infusion on in-hospital mortality in patients with septic shock and HR of > 90 beats/min, regardless of whether they are receiving mechanical ventilation. Dexmedetomidine was infused for 48 h to maintain the HR at 60 to 90 beats/min. Mechanically ventilated patients received conventional sedation in both groups. Other outcomes were the norepinephrine equivalent dose, the need for additional vasopressor, Acute Physiology and Chronic Health Evaluation (APACHE) II score, persistent atrial fibrillation (AF), and C-reactive protein (CRP) level., Results: In 90 patients of either sex, dexmedetomidine reduced the mean HR over the first 3 days in the ICU by 11.2 beats/min (95% CI, -17 to -5 beats/min; P < .001). The in-hospital mortality risk ratio (RR) was 0.68 (95% CI, 0.43-1.07; P = .091). The dexmedetomidine group received a norepinephrine equivalent dose of 0.55 μm/kg/min (interquartile range [IQR], 0.37-0.82 μm/kg/min) vs 0.61 μm/kg/min (IQR, 0.47-0.89 μm/kg/min; P = .121). Dexmedetomidine reduced the epinephrine infusion rescue (relative risk reduction, 0.6; 95% CI, 0.06-0.93; P = .025). The RR of persistent AF was 0.47 (95% CI, 0.21-0.99; P = .05). Dexmedetomidine reduced the median APACHE II score on the third day by -6 (95% CI, -10 to -2; P = .003) and the mean CRP concentration by -40 mg/dL (95% CI, -78 to -3.4 mg/dL; P = .033)., Interpretation: The study was underpowered to detect a reduction in in-hospital mortality or norepinephrine equivalent dose in patients with septic shock with dexmedetomidine. However, dexmedetomidine may reduce epinephrine infusion rescue, persistent AF, APACHE II score, and CRP., Clinical Trial Registry: ClinicalTrials.gov; No.: NCT05283083; URL: www., Clinicaltrials: gov., Competing Interests: Financial/Nonfinancial Disclosures None declared., (Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Background and Objectives: Stereotactic radiosurgery (SRS) represents an effective treatment for nonfunctioning pituitary adenomas (NFPAs). However, no data have yet been published regarding results of SRS on NFPAs after multiple previous resections., Methods: Retrospective multicentric data of patients diagnosed with NFPA and who underwent multiple resections (≥2) before SRS were reviewed and analyzed. The treatment interval spanned the period of 1992 to 2022. Cox regression and Kaplan-Meier curves were used to assess predictive factors and the probability of tumor control and hypopituitarism., Results: Among the 311 patients (median age: 50.2 [IQR: 18.0] years), 226 (72.7%) had undergone ≥2 previous resections. The median margin dose was 14 Gy (IQR: 4.0 Gy), and the median tumor volume 3.6 cm3 (IQR: 4.8). Overall, the probability of tumor control after SRS was 93.3% (CI 95%: 89.9-96.9) and 86.7% (CI 95%: 81.1-92.6) at 5 and 10 years, respectively. A margin dose >14 Gy was associated with a decreased risk of tumor progression (hazard ratio = 0.33, CI 95% = 0.15-0.75, P = .008). At a last clinical follow-up of 4.1 (IQR 6.1) years, 10.1% (30/296) developed at least 1 new hormone deficiency after SRS. The cumulative probability of new hormone deficiency was 6.1% (95% CI: 3.0-9.1), 10.3% (95% CI: 5.8-14.6), and 18.9% (95% CI: 11.5-25.8) at 3, 5, and 10 years after SRS, respectively. The average latency between SRS and development of new hormone deficiencies was 3.3 years (IQR 4.1). A maximum point dose to the pituitary stalk >10 Gy was associated with a new deficiency (hazard ratio = 4.06, CI 95% = 1.57-10.5, P-value = .004)., Conclusion: For patients with NFPA with multiple previous resections, SRS offers effective local tumor control and a low risk of delayed hypopituitarism for managing these challenging adenomas. SRS should be strongly considered in patients with NFPA with 2 previous resections compared with considering a third resection., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Background: Stereotactic radiosurgery (SRS) is used to treat recurrent or residual nonfunctioning pituitary neuroendocrine tumors (NFPA). The objective of the study was to assess imaging and development of new pituitary hormone deficiency., Methods: Patients treated with single-session SRS for a NFPA were included in this retrospective, multicenter study. Tumor control and new pituitary dysfunction were evaluated using Cox analysis and Kaplan-Meier curves., Results: A total of 869 patients (male 476 [54.8%], median age at SRS 52.5 years [Interquartile range (IQR): 18.9]) were treated using a median margin dose of 14Gy (IQR: 4) for a median tumor volume of 3.4 cc (IQR: 4.3). With a median radiological follow-up of 3.7 years (IQR: 4.8), volumetric tumor reduction occurred in 451 patients (51.9%), stability in 364 (41.9%) and 54 patients (6.2%) showed tumor progression.The probability of tumor control was 95.5% (95% Confidence Interval [CI]: 93.8-97.3) and 88.8% (95%CI: 85.2-92.5) at 5 and 10 years, respectively. A margin dose >14 Gy was associated with tumor control (Hazard Ratio [HR]:0.33, 95% CI: 0.18-0.60, P < 0.001). The probability of new hypopituitarism was 9.9% (95% CI: 7.3-12.5) and 15.3% (95% CI: 11-19.4) at 5 and 10 years, respectively. A maximum point dose >10 Gy in the pituitary stalk was associated with new pituitary hormone deficiency (HR: 3.47, 95% CI: 1.95-6.19). The cumulative probability of new cortisol, thyroid, gonadotroph, and growth hormone deficiency was 8% (95% CI: 3.9-11.9), 8.3% (95% CI: 3.9-12.5), 3.5% (95% CI: 1.7-5.2), and 4.7% (95% CI: 1.9-7.4), respectively at 10 years., Conclusions: SRS provides long-term tumor control with a 15.3% risk of hypopituitarism at 10 years., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

To investigate the effectiveness of AcceleDent Aura vibrating device on the rate of canine retraction. Thirty-two patients requiring extraction of upper first premolars and canine retraction were randomly allocated with a 1:1 ratio into either no-appliance group or the AcceleDent Aura appliance group. Canine retraction was done applying 150gm of retraction force using NiTi coil springs on 16 × 22 stainless steel archwires. The duration of the study was 4 months. Models were collected and digitized directly after extraction of upper first premolars and at monthly intervals during canine retraction for recording the monthly as well as the total distance moved by the canine. Digitized models were superimposed on the initial model and data were statistically analyzed. Anchorage loss, rotation, tipping, torque and root condition were evaluated using cone beam computed tomography imaging. Pain was evaluated by visual analog scale. No patients were dropped-out during this study. There was no statistically significant difference between both groups regarding the total distance travelled by the canine (P = 0.436), as well as the rate of canine retraction per month (P = 0.17). Root condition was the same for the two groups. Regarding the pain level, there was no statistically significant difference between the two groups at day 0 (P = 0.721), after 24 h (P = 0.882), after 72 h (P = 0.378) and after 7 days (P = 0.964). AcceleDent Aura was not able to accelerate orthodontic tooth movement. Pain level couldn't be reduced by vibrational force with an AcceleDent device during orthodontic treatment. Root condition was not affected by the vibrational forces., (© 2024. The Author(s).)

Background: Canine retraction has been successful with various force systems and retraction techniques. The appointment interval for force reactivation in canine retraction along the archwire is 4-8 weeks., Aims: The aim was to evaluate the effect of different reactivation intervals on the rate of space closure., Settings and Design: This split-mouth randomized clinical trial recruited 38 patients indicated for the first premolar extraction., Methods: Monthly digital models were acquired for 6 months. The first premolars were extracted, and temporary anchorage devices were placed for maximum anchorage control. The canines were retracted using elastomeric chains which were replaced every 2, 4, 6, or 8 weeks. The monthly rate of canine retraction was measured. The time to space closure was calculated. The secondary outcome was the mesial drift of the first molars., Statistical Analysis: The Kaplan-Meier survival analysis and the Friedman test evaluated and compared the groups., Results: There was no significant difference between the monthly canine retraction rate or the first molar mesial drift between the groups. The mean time to space closure was 5.74 months in the 2-week reactivation group, which was statistically less than the other groups., Conclusions: The 2-week reactivation interval may reduce time to space closure. Direct anchorage control with miniscrews limited anchorage loss significantly., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Contemporary Clinical Dentistry.)

Background: Myopia is the most prevalent form of refractive error that has a major negative impact on visual function and causes blurring of vision. We aimed to determine if Repeated Low-Level Red Light (RLRL) treatment is beneficial in treating childhood myopia in terms of axial length (AL), spherical equivalent refraction (SER), and sub foveal choroidal thickness (SFCT)., Methods: This systematic review was performed on RLRL for treatment of myopia in children compared to single vision spectacles (SVS). We employed the search strategy with key terms myopia and low-level light therapy then we searched PubMed, Scopus, Cochrane, and Web of Science databases. The mean differences (MD) were used to evaluate the treatment effects. Heterogeneity was quantified using I 2 statistics and explored by sensitivity analysis., Results: Five randomized controlled trials (RCTs) were included in our meta-analysis with a total of 833 patients, 407 in treatment group and 426 in control group. At a 3 month follow up period, pooled studies show a statistical difference in AL between RLRL and SVS group (MD = -0.16; 95% CI [-0.19, -0.12], SER (MD = 0.33; 95% CI [0.27, 0.38]), and SFCT (MD = 43.65; 95% CI [23.72, 45.58]). At a 6 month follow up period, pooled studies show a statistical difference in AL between RLRL and SVS group (MD = -0.21; 95% CI [-0.28, -0.15]), SER (MD = 0.46; 95% CI [0.26, 0.65]), and SFCT (MD = 25.07; 95% CI [18.18, 31.95]). At a 12 month follow up period, pooled studies show a statistical difference in AL between RLRL and SVS group (MD = -0.31; 95% CI [-0.42, -0.19]) and SER (MD = 0.63; 95% CI [0.52, 0.73])., Conclusion: This is the first systematic review and meta-analysis investigating only RCTs evidence supporting the efficacy of 650 nm RLRL for myopia control in the short term of 3, 6, and 12 months follow up. The present review revealed the clinical significance of RLRL as a new alternative treatment for myopia control with good user acceptability and no documented functional or structural damage. However, the effect of long-term RLRL treatment and the rebound effect after cessation require further investigations., (© 2024. The Author(s).)

Membrane sweeping is considered a simple and effective method for initiating spontaneous onset of labor. Despite the widely accepted membrane sweeping use to prevent post-term birth, the optimal frequency has not been estimated. We aimed to assess the effectiveness and safety of twice-weekly versus once-weekly membrane sweeping in post-term pregnancy prevention. Four different databases were searched for available clinical trials from inception to October 2022. We selected randomized controlled trials (RCTs) that compared twice-weekly membrane sweeping in intervention group versus once-weekly membrane sweeping in control group among pregnant women with singleton pregnancy at ≥ 39 gestational weeks. Our primary outcomes were the rate of spontaneous onset of labor and the requirement for formal methods of labor induction. Our secondary outcomes were sweeping to delivery interval in days, gestational age at delivery in weeks, Bishop score at admission, chorioamnionitis, and premature rupture of membranes. Three RCTs (596 patients) were included. Twice-weekly membrane sweeping was associated with significant increase in the rate of spontaneous onset of labor and significant decline in labor induction rate in comparison with once-weekly group. Duration from sweeping to delivery was significantly shorter among the twice-weekly group (p<0.001). Furthermore, gestational age at delivery was significantly earlier in the twice-weekly group. A significantly higher Bishop score at admission was observed in the twice-weekly group (p=0.02). There were no significant differences across both groups in chorioamnionitis and premature rupture of membranes. In conclusion, twice-weekly membrane sweeping is more effective in preventing post-maturity pregnancy than once-weekly sweeping without added adverse events., (© 2023. The Author(s), under exclusive licence to Society for Reproductive Investigation.)

The dentigerous cyst is a developmental odontogenic asymptomatic cyst, that is associated with the crown of an unerupted or impacted tooth. Early diagnosis is important to avoid any future complications and choose the best treatment option. The purpose of this case report is to describe the management of a dentigerous cyst related to lower second molar in a young female patient using orthodontic traction as a conservative treatment approach. This procedure helps to spare the patient an unnecessary surgical excision procedure and the associated excessive bone removal for a safety margin, stimulates bone healing and promotes the eruption of the cyst-associated tooth., (© 2023. The Author(s).)

Objective: To assess the relation of thrombotic markers, thrombomodulin and D-dimer levels to the disease severity in pediatric onset systemic lupus erythematosus (p-SLE) measured by the Systemic Lupus Erythematous Disease Activity Index (SLEDAI)., Methods: 40 children with p-SLE were grouped according to SLEDAI into: low activity SLE group (laSLE) and moderate-high activity SLE group (mhaSLE). 40 healthy children were included as control group. Serum thrombomodulin, and D-dimer levels were measured for all enrolled children., Results: The low activity and moderate-high activity SLE groups had significantly higher mean (SD) thrombomodulin [7.2 (1.83) mg/mL and 9.86 (3.29) mg/mL, respectively vs 5.85 (1.41) mg/mL; P<0.001] and D-dimer (r=0.42, P=0.006) levels than controls. Furthermore, the mhaSLE group had significantly higher thrombomodulin levels and D-dimer (r = 0.42, P= 0.006) levels than the laSLE group (P=0.008 and 0.006). Thrombomodulin and D-dimer had significant positive correlations with SLEDAI., Conclusion: Thrombomodulin and D-dimer are valuable markers for p-SLE activity, discriminating children with severe disease activity from those with low disease activity.

Recently, various research studies have been developed to address communication sensors for Unmanned Aerial Systems (UASs). In particular, when pondering control difficulties, communication is a crucial component. To this end, strengthening a control algorithm with redundant linking sensors ensures the overall system works accurately, even if some components fail. This paper proposes a novel approach to integrate several sensors and actuators for a heavy Unmanned Aerial Vehicle (UAV). Additionally, a cutting-edge Robust Thrust Vectoring Control (RTVC) technique is designed to control various communicative modules during a flying mission and converge the attitude system to stability. The results of the study demonstrate that even though RTVC is not frequently utilized, it works as well as cascade PID controllers, particularly for multi-rotors with mounted flaps, and could be perfectly functional in UAVs powered by thermal engines to increase the autonomy since the propellers cannot be used as controller surfaces.

The current study was conducted to evaluate the immunoenhancement effect of Moringa oleifera leaves alcoholic extract (MOLE) versus Oregano essential oil (OEO) against cyclophosphamide induced immunosuppression in broilers chicks. A total of a three hundred one-day-old chicks were assigned randomly into three main dietary groups, control, MOLE, and OEO for 14 days. After 14 days the three main experimental groups were subdivided into six groups, control, cyclophosphamide, MOLE, MOLE and Cyclophosphamide, OEO, and OEO and cyclophosphamide. Each group of these six groups was subdivided into three subgroups. Supplementation of broiler chicks with MOLE and OEO for 14 days significantly increased body weight compared to the control group. However, injection of broiler chicks with cyclophosphamide significantly induced body weight loss, impaired immunological response represented by decreasing total leukocytic count, differential leukocytic count, phagocytic activity, phagocytic index, and hemagglutinin inhibition titer for New Castle disease virus, lymphoid organs depletion, and increased the mortality rate. In contrast, supplementation of cyclophosphamide treated chicks with MOLE and OEO significantly reduced cyclophosphamide induced body weight loss and impaired immunological responses, as it showed significant increase in body weight, total leukocytic count, differential leukocytic count, phagocytic activity, phagocytic index, and hemagglutinin inhibition titer for New Castle disease virus, lymphoid organs proliferation, and reduced the mortality rate. This study indicated that MOLE and OEO supplementation ameliorated cyclophosphamide induced body weight loss and impaired immunological responses., (© 2023. The Author(s).)

A systematic study integrating laboratory, analytical, and case study field trial was conducted to figure out the effective adsorbent that could be used for the removal of Congo red (CR) dye from industrial wastewater effluent. The ability of the zeolite (Z) to adsorb CR dye from aqueous solutions was evaluated after it was modified by the Cystoseira compressa algae (CC) (Egyptian marine algae). Zeolite, CC algae were combined together in order to form the new composite zeolite/algae composite (ZCC) using wet impregnation technique and then characterized by the aid of different techniques. A noticeable enhancement in the adsorption capacity of newly synthesized ZCC was observed if compared to Z and CC, particularly at low CR concentrations. The batch style experiment was selected to figure out the impact of various experimental conditions on the adsorption behavior of different adsorbents. Moreover, isotherms and kinetics were estimated. According to the experimental results, the newly synthesized ZCC composite might be applied optimistically as an adsorbent for eliminating anionic dye molecules from industrial wastewater at low dye concentration. The dye adsorption on Z and ZCC followed the Langmuir isotherm, while that of CC followed the Freundlich isotherm. The dye adsorption kinetics on ZCC, CC, and Z were agreed with Elovich, intra-particle, and pseudo-second-order kinetic models, correspondingly. Adsorption mechanisms were also assessed using Weber's intraparticle diffusion model. Finally, field tests showed that the newly synthesized sorbent has a 98.5% efficient in eliminating dyes from industrial wastewater, authorizing the foundation for a recent eco-friendly adsorbent that facilitate industrial wastewater reuse., (© 2023. The Author(s).)

Given the significant role the heat shock protein Hsp70 plays in modulating cellular homeostasis in several chronic inflammatory disorders, the genetic variation of the inducible HSP70 ( HSPA1B ) gene may impact protein expression and disease phenotype. The HSPA1B rs2763979 variant has been associated with multiple inflammatory scenarios, but no previous studies have explored its association with asthma. In this sense, this cross-sectional study enrolled 90 children with asthma and 218 age-/sex-matched healthy volunteers for rs2763979 variant genotyping by TaqMan allelic discrimination analysis. The results were investigated under several genetic models and associated with disease susceptibility and clinicolaboratory data. Overall analysis, including the 308 participants, revealed a higher C allele frequency among patients relative to controls (43.0% vs. 33%, p = 0.006). Furthermore, patients with the C variant initially had a higher risk of asthma under heterozygous (OR = 2.75, 95%CI = 1.46-5.18, p = 0.003), homozygous (OR = 3.35, 95%CI = 1.19-9.39, p = 0.008), dominant (OR = 2.83, 95%CI = 1.52-5.25, p < 0.001), and overdominant (OR = 2.12, 95%CI = 1.20-3.74, p = 0.008) models. However, after employing a 1:1 nearest propensity matching analysis, the studied variant showed only borderline significance with asthma under the dominant model in 71 matched cohorts. Interestingly, patients who carry the rs2763979 CC genotype showed favorable spirometric parameters in terms of better (mean ± SD) forced vital capacity (86.3 ± 7.4 vs. 77.7 ± 6.1 and 75.7 ± 7.2 for CT and TT, respectively, p = 0.021), forced expiratory volume in one second before bronchodilation (60.7 ± 12.9 vs. 54.9 ± 7.6 and 56.1 ± 7.5 for CT and TT, respectively, p = 0.021), and an improvement in peak expiratory flow rate after inhaled salbutamol bronchodilator ( p = 0.044) relative to the counterpart genotypes. In conclusion, the HSPA1B rs2763979 variant might have prognostic utility as a genetic marker for asthma in our population. Further larger studies on different ethnicities are recommended to validate the results.

Background: Coronavirus disease 2019 (COVID-19) is a pandemic caused by the SARS-CoV-2 virus. Many efforts have been made and are currently being made to prevent and treat this global disease., Objectives: This study was designed to evaluate the efficacy and safety of nebulized ethanol (EtOH) in treating COVID-19., Methods: A randomized clinical trial (RCT) of 99 symptomatic and real-time polymerase chain reaction (RT-PCR)-positive patients admitted to a hospital receiving remdesivir-dexamethasone was conducted. They were randomly assigned to receive distilled water spray (control group (CG)) or 35% EtOH spray (intervention group (IG)). Both groups inhaled three puffs of spray (nebulizer) every six hours for a week. The primary outcome included Global Symptomatic Score (GSS) between the two groups at the first visit and on days three, seven, and 14. Secondary outcomes included the Clinical Status Scale (CSS; a seven-point ordinal scale ranging from death to complete recovery) and readmission rate., Results: A total of 44 and 55 patients were enrolled in the IG and CG, respectively. Although there was no difference at admission, the GSS and CSS improved significantly in the IG (p = 0.016 and p = 0.001, respectively). The IG readmission rate was considerably lower (0% vs. 10.9%; p = 0.02)., Conclusions: Inhaled-nebulized EtOH is effective in rapidly improving the clinical status and reducing further treatment. Due to its low cost, availability, and absent/tolerable adverse events, it could be recommended as an adjunctive treatment for moderate COVID-19. Further research on curative effects in more serious cases and in prevention is advisable., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Amoushahi et al.)

DWI involves acquisition of signal of movement of water proton in cellular spaces of body (Brownian motion). It includes qualitative method either restricted or facilitated and quantitive method which is apparent diffusion coefficient value(ADC) which is related to proportion of extracellular and intracellular components of the tissue., ADC is calculated with use of at least two b value more accurate using more DWI with different b value,ADC levels is low in increased tissue cellularity, as malignancy., ADC levels is high in non-tumoral tissue alterations such as direct endoscopy oedema, radiotherapy necrosis are expected to have minimal cellularity. ADC is most accurate in the detection of malignancy versus tissue edema or radionecrosis the aim of study to assess value of ADC as regarding measuring sensitivity and specificity and accuracy to differentiate tumor recurrence from radionecrosis. This study includes 36 patients who were suspected patients of tumor recurrence after radiotherapy; it is a prospective randomized comparative clinical trial. The patients were assessed using direct laryngoscopic examination under general anaesthesia and biopsy, and diffusion weighted image on the neck (b0 and b1000), ADC map and ADC value measured al lesion and normal tissues and compared with pathology results. ADC value (mean 0.93 ± 0.30 X 10 -3 mm 2 /s) in patients had recurrent carcinoma was significantly lower ( P  < .0001) than the mean ADC of normal tissue in the same patients (1.26 ± 0.134) while mean ADC of tumour recurrence ( P  < .0001) was lower than mean ADC value of radio necrosis (1.63 ± 0.21 × 10 -3 mm 2 /s). MRI ADC value is a sensitive and non-invasive method in detection of a recurrent laryngeal lesion from radionecrosis., Competing Interests: Conflict of interestThe authors have no conflict of interest to declare., (© Association of Otolaryngologists of India 2022.)

Background: The aim of this randomized controlled trial was to assess the effectiveness of taping alone in changing nose and lip aesthetics in infants with unilateral complete cleft lip and palate before and after surgical lip repair., Methods: The study design was a prospective, balanced, randomized, parallel-group, single-blinded, controlled trial. All the steps were carried out in the Department of Orthodontics of Cairo University in Egypt. Thirty-one infants with nonsyndromic unilateral complete cleft lip and palate were randomly assigned to either no treatment (control) or taping groups. In the taping group, all infants received horizontal tape between the two labial segments, aiming to decrease the cleft gap. No other interventions were performed in this group. Standardized photographs and videos were taken of the infants in both groups at the beginning of the treatment (T1), directly before surgical lip repair (T2), and 2 weeks after surgical lip repair (T3). Photographs and shots from videos were calibrated and used for outcome assessment. Blinded assessors carried out all the measurements digitally on the standardized photographs at T1, T2, and T3 using computer software., Results: Significant changes in all the measurements were recorded in the taping group at T2 before surgical lip repair in comparison with the control group. At T3, no differences were found between the two groups., Conclusions: Taping is a successful intervention in changing nose and lip aesthetics before surgical lip repair. After surgical lip repair, both groups had matching aesthetics., Clinical Question/level of Evidence: Therapeutic, I., (Copyright © 2022 by the American Society of Plastic Surgeons.)

This paper proposes the design of the communications, control systems, and navigation algorithms of a multi-UAV system focused on remote sensing operations. A new controller based on a compensator and a nominal controller is designed to dynamically regulate the UAVs' attitude. The navigation system addresses the multi-region coverage trajectory planning task using a new approach to solve the TSP-CPP problem. The navigation algorithms were tested theoretically, and the combination of the proposed navigation techniques and control strategy was simulated through the Matlab SimScape platform to optimize the controller's parameters over several iterations. The results reveal the robustness of the controller and optimal performance of the route planner.

Beta thalassemia is associated with decreased immunity possibly due to iron overload. Al-hijamah (Hijamah) is wet cupping therapy (WCT) of prophetic medicine. Prophet Muhammad Peace be upon him said: "The best among your treatments is Al-hijamah". Al-hijamah is a promising excretory treatment to clear blood of causative pathological substances. Al-hijamah is a three-step technique (skin suction, scarification and suction) i.e. triple S technique). Recently, we introduced Al-hijamah as a novel iron excretion therapy (through pressure-dependent filtration then excretion via the skin dermal capillaries) that significantly decreased serum iron overload and related oxidative stress using a physiological excretory mechanism (Taibah mechanism). Iron overload was reported to impair both humoral immunity and cell mediated immunity in patients with beta thalassemia. In this study, twenty patients having β-thalassemia major (maintained on iron chelation therapy) underwent a single session of Al-hijamah (30-60 minutes) using 4-5 sucking cups only. Another age and sex-matched control group of thalassemic patients received iron chelation therapy only. Al-hijamah enhanced the immunity of thalassemic patients in the form of increased CD4 + T cell count, from 124.10±36.98 to 326.20±57.94 cells/mm 3 , and an increased CD8 + T cell count from 100.30±36.98 to 272.40±46.37 cells/mm 3 . CD4/CD8 ratio significantly increased from 1.29 to 1.7 (P<0.001). There was a significant increase of ten times (P<0.001) in serum TAC/MDA ratio (reflects increased antioxidant capacity vs decreased oxidative load and stress) induced by Al-hijamah. After Al-hijamah, both CD4 + and CD8 + T cell counts significantly increased and positively correlated with TAC/MDA ratio (r = 0.246) and (r = 0.190), respectively. Moreover, CD4/CD8 ratio positively correlated with TAC/MDA after Al-hijamah (r = 0.285). In conclusion, Al-hijamah significantly increased CD4/CD8 ratio in thalassemic patients via increasing TAC/MDA ratio. Our study strongly recommends medical practice of Al-hijamah in hospitals for its immune potentiating effects in agreement with the evidence-based Taibah mechanism. Al-hijamah should be generalized for treating other immune-deficiency conditions. Al-hijamah-induced bloody excretion is so minimal and never aggravates the anaemic status., Competing Interests: None., (AJBR Copyright © 2022.)

Background: Studies regarding treatment of acute toxicity with diclofenac (ATD) are quite few. Diclofenac is commonly prescribed in neurology, psychiatry, and general medicine practice. This study investigated possible colon-protective effects exerted by Ajwa date fruit extract (ADFE), a prophetic medicine remedy native to Al-Madinah, Saudi Arabia against ATD. Phytochemicals in ADFE as gallic acid and quercetin have reported protective effects against ATD., Methods: Total phenols and flavonoids in ADFE were estimated as equivalents to gallic acid and quercetin. Four experimental groups were allocated each of six rats: control group, ATD group received a single dose of 150 mg diclofenac intraperitoneally, toxicity prevention group received a single dose of ADFE orally followed 4 hours later by diclofenac injection, and toxicity treatment group received a similar diclofenac dose followed 4 hours later by a single dose of ADFE. Four days later, animals were sacrificed. Histological and biochemical examinations were done., Results: ADFE has a total phenolic content of 331.7 gallic acid equivalent/gram extract and a total flavonoid content of 70.23 quercetin equivalent/gram. ATD significantly increased oxidative stress markers as serum malondialdehyde (MDA) and hydrogen peroxide (H 2 O 2 ). Serum MDA and H 2 O 2 were significantly scavenged by ADFE. ATD significantly (p<0.001) decreased antioxidant power as serum total antioxidant capacity and catalase activity. That was reversed by ADFE in both prevention and treatment groups. Histologically, ATD caused complete destruction of colonic crypts architecture, patchy loss of the crypts, loss of the surface epithelium, absent goblet cells and submucosal exudate, heavy infiltration of the lamina propria and submucosa with inflammatory cells, mainly lymphocytes and eosinophils. There were mucosal haemorrhages and submucosal dilated congested blood vessels. All that was prevented and treated using ADFE., Conclusion: ADFE is rich in quercetin and gallic acid equivalents that exert potent antitoxic effects. ADFE is strongly recommended for preventive and therapeutic colon effects against ATD., Competing Interests: The authors report no conflicts of interest in relation to this work., (© 2022 Hassan et al.)

Forest fires are among the most dangerous accidents, as they lead to the repercussions of climate change by reducing oxygen levels and increasing carbon dioxide levels. These risks led to the attention of many institutions worldwide, most notably the European Union and the European Parliament, which led to the emergence of many directives and regulations aimed at controlling the phenomenon of forest fires in Europe, such as the (E.U.) 2019/570. Among the proposed solutions, the usage of unmanned aerial vehicles (UAVs) is considered to operate alongside existing aircraft and helicopters through extinguishing forest fires. Scientific researches in this regard have shown the high effectiveness use of UAVs. Still, some defects and shortcomings appeared during practical experiments represented in the limited operating time and low payload. As UAVs are used for firefighting forest fires, they must be characterized by the heavy payload for the extinguishing fluids, long time for flight endurance during the mission, the ability to high maneuver, and work as a decision-making system. In this paper, a new UAV platform for forest firefighting is represented named WILD HOPPER. WILD HOPPER is a 600-liter platform designed for forest firefighting. This payload capacity overcomes typical limitations of electrically powered drones that cannot be used for anything more than fire monitoring, as they do not have sufficient lifting power. The enhanced capabilities of the WILD HOPPER allow it to complement existing aerial means and overcome their main limitations, especially the need to cover night operations. This allows reducing the duration of the wildfires heavily by allowing continuous aerial support to the extinguishing activities once the conventional aerial means (hydroplanes and helicopters) are set back to the base at night. On the other hand, WILD HOPPER has significant powerful advantages due to the accuracy of the release, derived from multirotor platform dynamic capabilities., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors.)

Objective: Many studies still dispute the identification of independent risk factors that influence outcome after neonatal cardiac surgery. We present our study to announce the contemporary outcomes and risk profile of neonatal cardiac surgery at our institute., Methods: We designed a retrospective study of neonatal patients who underwent surgery for congenital heart diseases between June 2011 and April 2020. Demographic, operative, and postoperative data were collected from medical records and surgical databases. The primary outcome was the operative mortality (in-hospital death) and secondary outcomes included hospital length of stay, intensive care unit stay, duration of mechanical ventilation., Results: In total, 1155 cardiac surgeries in children were identified; of these, 136 (11.8%) were performed in neonates. Arterial switch operations (48 cases) were the most frequent procedures. Postoperatively, 11 (8.1%) patients required extracorporeal membrane oxygenation, and 4 (2.9%) patients had complete heart block. Postoperative in-hospital mortality was 11%. The median postoperative duration of mechanical ventilation, intensive care unit stay, and hospital length of stay were 6, 18, and 24 days, respectively., Conclusion: The early outcomes of neonatal cardiac surgery are encouraging. The requirement of postoperative extracorporeal membrane oxygenation support, postoperative intracranial hemorrhage, and acute kidney were identified as independent risk factors of mortality following surgery for congenital heart defects in neonates., (© 2022. The Author(s).)

A dependent step-by-step study that included experimental and field study was applied to explore the simplest and most effective system that could be applied for adsorption of Congo Red (CR) dye from the effluent of wastewater that comes out from different industries. Zeolite (Z) surface and pores were subjected to a modification process using green seaweed (GS) algae. Thereafter, each Z, GS, and composite from both were evaluated based on the adsorption efficacy to clean up CR dyes from aqueous solutions. A wet impregnation method was followed to fabricate the zeolite/algae (ZGS) nanocomposite which was characterized using the most appropriate characterization techniques. Batch experiments were selected to be the method of choice in order to follow up the performance of the adsorption process versus different practical variables. Moreover, dye adsorption kinetics and isotherms were investigated as well. At lowered concentrations of CR, the novel nanocomposite ZGS revealed more efficacy than its counterparts, Z and GS, in terms of the adsorption capacity. The maximum adsorption capacities were found to be 8.10, 10.30, and 19.70 mg/g for Z, GS, and ZGS, respectively. Laboratory tests confirmed that the novel nanocomposite ZGS could be introduced as a new and economical nanoadsorbent to capture and remove negatively charged dyes from wastewater effluents that come out from industries at lower concentrations of CR dye and analogous compounds. The dye adsorption on GS, Z, and ZGS coincide with the pseudo-first, Langmuir isotherm, and second-order models. Evaluation for the sorption mechanism was conducted using a diffusion model known as Weber's intraparticle. Depending on the last findings, field experiments on removing dyes from industrial wastewater revealed optimistic findings as the efficiency of our modern and eco-friendly nanoadsorbent reached 91.11%, which helps in the reuse of industrial wastewater., Competing Interests: The authors declare no competing financial interest., (© 2022 The Authors. Published by American Chemical Society.)

This paper deals with the problems and the solutions of fast coverage path planning (CPP) for multiple UAVs. Through this research, the problem is solved and analyzed with both a software framework and algorithm. The implemented algorithm generates a back-and-forth path based on the onboard sensor footprint. In addition, three methods are proposed for the individual path assignment: simple bin packing trajectory planner (SIMPLE-BINPAT); bin packing trajectory planner (BINPAT); and Powell optimized bin packing trajectory planner (POWELL-BINPAT). The three methods use heuristic algorithms, linear sum assignment, and minimization techniques to optimize the planning task. Furthermore, this approach is implemented with applicable software to be easily used by first responders such as police and firefighters. In addition, simulation and real-world experiments were performed using UAVs with RGB and thermal cameras. The results show that POWELL-BINPAT generates optimal UAV paths to complete the entire mission in minimum time. Furthermore, the computation time for the trajectory generation task decreases compared to other techniques in the literature. This research is part of a real project funded by the H2020 FASTER Project, with grant ID: 833507.

The impact of zinc oxide nanoparticles (ZnO-NPs) on the pathogenesis of coccidiosis in broiler chickens was tested. A total of 160 1-day-old broiler chicks (Ross 308) were randomly allocated into 4 groups (n = 40). Group 1: unchallenged, unmedicated; Group 2: challenged, unmedicated; Group 3: challenged, supplemented with diclazuril (1 ppm); Group 4: challenged, supplemented with ZnO-NPs (20 ppm). Mixed Eimeria species ( E. maxima , E. acervulina, &nbsp; E. mivati , and E. tenella ) of a commercial coccidial vaccine (FORTEGRA ® ) were used to perform the coccidial challenge by 15× of its vaccinal dose on the 14th day of age. Diclazuril and ZnO-NPs supplementation in Group 3 and 4, respectively, reduced the mortality rate due to coccidial challenge to 5.8% compared to 11.9% in Group 2. The growth performance was improved by ZnO-NPs in coccidiosis-infected group ( p ≤ 0.05) compared to Group 2 and was comparable to that of Group 3 ( p ≥ 0.05). The average oocyst count was lower in Groups 3 and 4 (7.8 × 10 3 and 14.3 × 10 3 , respectively) than in Group 2 (67 × 10 3 oocysts). Group 3 had a decreased gross lesion score in duodenum and caecum ( p ≤ 0.05) as well as jujenum and ileum ( p ≥ 0.05) compared to Group 2; while the average lesion scores of all intestinal parts in Group 4 were significantly decreased ( p ≤ 0.05). However, diclazuril was superior to ZnO-NPs in reducing caecal lesion score ( p ≤ 0.05). Plasma carotenoids levels were increased by diclazuril ( p ≥ 0.05) and ZnO-NPs ( p ≤ 0.05) supplementation compared to Group 2. Oxidative stress appeared on the fourth week post-challenge (pc) in Group 2 ( p ≤ 0.05) compared to Group 1, while the dietary supplementation with either diclazuril or ZnO-NPs numerically decreased Malondialdhyde ( p ≥ 0.05) and statistically increased antioxidant activity ( p ≤ 0.05). Both medications significantly improved the PCV%, Hb% and RBCs count on the 6th-day and 4th-week pc ( p ≤ 0.05) compared to Group 2, though this improvement was higher significantly in Group 4 than Group 3 on the 6th day pc ( p ≤ 0.05). Neither coccidial challenge nor medications had an impact on the total WBCs count as well as organ index, except Bursa of fabricious index that significantly improved by ZnO-NPs on the 4th-week pc compared to Group 2. Coccidial challenge reduced total protein and globulin levels and increased the serum alanine aminotransferase, serum cholesterol, and low-density lipoprotein levels ( p ≤ 0.05) compared to Group 1, while those of both medicated groups (Group 3 and 4) were comparable to Group 1 ( p ≥ 0.05). In conclusion, ZnO-NPs were found to be as effective as diclazuril against coccidiosis. However, further research is needed to fully comprehend its anticoccidial mechanisms.

Headache is one of the chronic disorders that can trigger sexual dysfunction due to complex mechanisms. This study recruited 120 consecutive patients from our outpatient clinics with migraine (n = 60), TTH (n = 60) as well as healthy age-matched controls (n = 60) for a total of 180 patients. All the participants were evaluated by the Arabic version of the female sexual function index (ArFSFI: 19 items), the abridged 5-item version of the international index of erectile function (IIEF-5), hospital anxiety and depression scale (HADS: 14 items), visual analog scale (VAS) score, and the headache impact test questionnaire (HIT-6TM: 6 items). A significant correlation was noticed between scores of total ArFSFI in women with TTH and their partners' IIEF-5 scores (r = 0.773, p < 0.001). In contrast, significant negative correlations were also found between scores of total ArFSFI in women with migraine(r - 0.327, p 0.011), HADS-A scores (r - 0.504, p < 0.001), HADS-D scores (r - 0.579, p < 0.001), HITS scores (r - 0.413, p 0.001), VAS scores (r 0.737, p < 0.001), and their partners' IIEF-5 scores (r - 0.839, p < 0.001). Interestingly, our study had shown a bidirectional relation between SD, anxiety, and depression subscales of HADS in females with migraine only (28.49 ± 9.46, 13.54 ± 4.44, 15.17 ± 7.73 respectively, p 0.009), while females with migraine and SD reported statistical higher scores of anxiety and depression (25.21 ± 11.70, 12.71 ± 4.20, 17.95 ± 8.05, respectively, p 0.006). This study had demonstrated that drug-naïve Egyptian females with migraine are more prone to SD than those with TTH., (© 2020. Belgian Neurological Society.)

A comprehensive study combined experimental, computational and field experiments was conducted to find out the most appropriate adsorbent system for industrial elimination of congo red (CR) dye from simulated industrial wastewater. Modification of the zeolite (Z) by the Padina gymnospora algae (PG) (Egyptian marine algae) was evaluated in terms of the adsorption capability of the zeolite (Z) to remove CR dye from aqueous solutions. The zeolite/algae composite (ZPG) was fabricated using the wet impregnation technique. Various techniques were used to characterize the PG, Z, and the produced ZPG nanocomposite. Batch experiments were performed to study the influence of various practical variables on adsorption processes. The isotherms and kinetics of dye adsorption were also studied. The newly synthesized ZPG nanocomposite exhibits much higher adsorption capacity, especially at low CR concentrations than that of Z. The computational calculations have shown that owing to the presence of intermolecular interactions, the adsorption of the CR molecule on zeolite surfaces is exothermic, energetically favorable, and spontaneous. For all configurations, increasing the zeolite size does not have a noticeable impact on the adsorption energies. The experimental results revealed that the ZPG nanocomposite can be applied as an economical nanoadsorbent to eliminate anionic dyes from simulated industrial wastewater at low CR dye concentrations. The adsorption isotherm of dye onto Z, PG, and ZPG almost agreed with Langmuir isotherm and pseudo-second-order kinetics. The sorption mechanism was also evaluated using Weber's intra-particle diffusion module. Finally, the field experiments revealed optimistic results for the newly synthesized adsorbent in removing dyes from industrial wastewater with 82.1% efficiency, which in turn confirmed the foundation of new eco-friendly materials that aid in the reuse of industrial wastewater., (© 2021. The Author(s).)

Objective: The aim of this study was to identify an association between the severity of COVID-19 in obese-diabetic patients and altered serum levels of MMP-7, MMP-9, TGF-β, and PDGF macrophage activation markers., Methodology: The study included 70 COVID-19 patients, divided into two groups: Group 1 included: Obese COVID-19 patients with type 2 diabetes mellitus (T2D, n=22 patients) and group 2 included; non-obese, non-diabetic COVID-19 patients as an age- and sex-matched control group (n=48 patients). Serum levels of the tested biomarkers were measured by ELISA at admission and after one weak follow-up., Results: There was a significant reduction in the serum levels of LBP in obese-diabetic COVID-19 patients versus the control group (8.34±3.94 vs 20.78±7.61) (p 0.0001). Significant elevation of MMP-7, MMP-9, PDGF and TGF-β was detected in obese diabetic COVID-19 patients compared to the non-obese non-diabetic group: 1044.7±519.6 vs 405.6±164.1, 483.05±46.5 vs 173.31±76.26, 154.5±62.78 vs 39.77±21.52, and 603.05±258.82 vs 180.29±97.17, respectively. The serum levels of macrophage activation markers in obese-diabetic patients one week after admission revealed that patients with acute respiratory distress syndrome (ARDS) had significantly higher serum levels of MMP-7 and MMP-9 than non-ARDS patients (p 0.02 and p 0.01 respectively)., Conclusion: Macrophages were mainly polarized towards the M2 phenotype in obese-diabetic COVID-19 patients with significant upregulation of the pro-fibrotic markers MMP-7, MMP-9, PDGF, and TGF-β. Thus, high levels of MMP-7 and MMP-9 are associated with ARDS in severe COVID-19 disease among obese-diabetic patients., Competing Interests: The authors declare that they have no financial or non-financial conflicts of interest related to the work reported in the manuscript. Each author listed in the manuscript saw and approved the submission of this version of the manuscript and takes full responsibility for it. This article had not been published elsewhere and is not currently under consideration by another journal or a publisher., (© 2021 Nasr El-Din et al.)

Systematic investigations involving laboratory, analytical, and field trials were carried out to obtain the most efficient adsorbent for the removal of congo red (CR) dye from industrial effluent. Modification of the zeolite (Z) by the Acanthophora Spicifera algae (AS; marine algae) was evaluated in terms of adsorption capability of the zeolite to remove CR dye from aqueous solution. The zeolite/algae composite (ZAS) was fabricated using the wet impregnation technique. The AS, Z, and the synthesized ZAS composite were analyzed utilizing various characterization techniques. The newly synthesized ZAS composite has an adsorption capacity that is significantly higher than that of Z and AS, particularly at low CR concentrations. Batch experiments were carried out to explore the effects of different experimental factors, as well as the dye adsorption isotherms and kinetics. Owing to the presence of intermolecular interactions, the computational analysis showed that the adsorption of the CR molecule on zeolite surfaces is exothermic, energetically favorable, and spontaneous. Furthermore, growing the zeolite surface area has no discernible effect on the adsorption energies in all configurations. The ZAS composite may be used as a low-cost substitute adsorbent for the removal of anionic dyes from industrial wastewater at lower dye concentrations, according to the experimental results. Adsorption of CR dye onto Z, AS, and ZAS adsorbents was adequately explained by pseudo-second-order kinetics and the Langmuir isotherm. The sorption mechanism was also evaluated using Weber's intra-particle diffusion module. Finally, field testing revealed that the newly synthesized adsorbent was 98.0% efficient at extracting dyes from industrial wastewater, proving the foundation of modern eco-friendly materials that aid in the reuse of industrial wastewater.

Background: The purpose of this study was to explore the diagnostic role of sTREM1 in the diagnosis of sepsis and in differentiating between sepsis and systemic inflammatory response syndrome (SIRS). We also aimed to assess the prognostic value of suPAR in comparison to sequential organ-failure assessment (SOFA), acute physiology and chronic health evaluation (APACHE) II scores, and 28-day mortality., Methods: This was a cross-sectional study conducted in the Medical Microbiology and Immunology Department and Central Research Laboratory, Faculty of Medicine, Sohag University from June 2019 to January 2021. The study population was classified into two groups: SIRS (no evidence of infection) and sepsis (with SIRS and evidence of infection). Patients were rated on the SOFA and APACHE II scoring systems at admission and after 7 days. Serum levels of sTREM1 and suPAR were measured by ELISA at the same time points., Results: CRP and sTREM1 values were significantly higher in the sepsis group than the SIRS group on both days ( P <0.0001). The area under the curve (AUC) for CRP was 0.87 on the first day and 0.97 on the seventh, while the AUC for sTREM1 was 1.00 and 0.93 on the first and seventh days, respectively. The sensitivity of sTREM1 was 100% and specificity 84% at a cutoff of 49 pg/mL. There was a significantly positive correlation between CRP and sTREM1 values ( P <0.0001). On the seventh day, nonsurvivors had significantly higher serum levels of suPAR (median 4.9 ng/mL) than survivors (median 2.9 ng/mL; P <0.0001). Nonsurvivors also had significantly higher SOFA and APACHE II scores than survivors ( P <0.0001 and P <0.0001, respectively)., Conclusion: sTREM1 can be used as a good indicator for diagnosing sepsis in intensive care-unit patients. suPAR can also be used as a predictor of bad prognosis and poor survival at 7 days following admission., Competing Interests: The authors declare that they have no financial or nonfinancial conflicts of interest related to the work reported in the manuscript. Each author listed in the manuscript has seen and approved the submission of this version of the manuscript and takes full responsibility for it. This article has not been published anywhere, and is not currently under consideration by another journal or publisher., (© 2021 Nasr El-Din et al.)

Hepatocellular carcinoma (HCC) is one of the ten most commonly diagnosed cancers. Doxorubicin is an antibiotic used in cancer treatment protocols that has several side effects. L-Arginine is a non-essential amino acid that is used as immune system activation and antitumor drugs. Therefore, the current study was designed to compare using doxorubicin, L-arginine, or their combination as a prophylactic agent against hepatic carcinoma induced by hepatocellular carcinoma cells (HepG2) injection in mice. The mice were divided into five groups: normal mice and mice that received HepG2, doxorubicin and HepG2, L-arginine and HepG2, and doxorubicin, L-Arginine, and HepG2, respectively. Liver function test as, aspartate transaminase (AST) and alanine transaminase (ALT), and alpha-fetoprotein (AFP), caspase 3, interleukin 6 (IL-6), tumor necrotic factor (TNF), lipid peroxidation (NDA), and some antioxidant parameters were determined. A significant increase in AST and ALT, α-fetoprotein, TNF-α, and cytokines IL6 and MDA and a significant decrease in the serum caspase and liver catalase were determined in HepG2-injected mice. Moreover, some large hyperchromatic heptocytes were observed and the percentage of the positive area/field of HepPar-1, the most specific HCC marker, was 9.56%. Interestingly, mice that received doxorubicin, L-arginine, or their combination showed an improvement in some of the previous parameters. The improvement was more prominent with L-arginine administration., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Re-exploration of bleeding after cardiac surgery is associated with significant morbidity and mortality. Perioperative blood loss and rate of re-exploration are variable among centers and surgeons., Objective: To present our experience of low rate of re-exploration based on adopting checklist for hemostasis and algorithm for management., Methods: Retrospective analysis of medical records was conducted for 565 adult patients who underwent surgical treatment of congenital and acquired heart disease and were complicated by postoperative bleeding from Feb 2006 to May 2019. Demographics of patients, operative characteristics, perioperative risk factors, blood loss, requirements of blood transfusion, morbidity and mortality were recorded. Logistic regression was used to identify predictors of re-exploration and determinants of adverse outcome., Results: Thirteen patients (1.14%) were reexplored for bleeding. An identifiable source of bleeding was found in 11 (84.6%) patients. Risk factors for re-exploration were high body mass index, high Euro SCORE, operative priority (urgent/emergent), elevated serum creatinine and low platelets count. Re-exploration was significantly associated with increased requirements of blood transfusion, adverse effects on cardiorespiratory state (low ejection fraction, increased s. lactate, and prolonged period of mechanical ventilation), longer intensive care unit stay, hospital stay, increased incidence of SWI, and higher mortality (15.4% versus 2.53% for non-reexplored patients). We managed 285 patients with severe or massive bleeding conservatively by hemostatic agents according to our protocol with no added risk of morbidity or mortality., Conclusion: Low rate of re-exploration for bleeding can be achieved by strict preoperative preparation, intraoperative checklist for hemostasis implemented by senior surgeons and adopting an algorithm for management.

Public prophylaxis to decrease the emergence of new daily COVID-19 cases is vital. Adjuvant TaibUVID nutritional supplements are promising home-made or hospital-made supplements suggested for rapidly preventing and treating COVID-19 pandemic. We report here a 44 years old male physician who caught COVID-19 infection at hospital in Egypt with confirmed positive nasopharyngeal swab PCR. Ethical committee approval and informed patient's consent were gained before performing this study. Chest X-ray revealed increased bronchovascular markings. Close follow-up was done with no treatment given and he was sent for home isolation. Few days later, he developed progressive non-productive cough and a sense of difficult breathing with no associated fever or chest pain. An antitussive drug was given to him. The patient read about TaibUVID supplements from social media and started to feel improvement after TaibUVID inhalation therapy (using the heated solution of nigella sativa and chamomile five times a day). He also received a home-made TaibUVID nutritional supplement (nigella sativa, chamomile and natural honey) five times daily for four consecutive days. The next day, he was quite better with mild symptoms. Two days later, nasopharyngeal swab PCR was negative while other patients still had positive nasopharyngeal swabs. As few attacks of mild cough and breathing difficulty existed, he was admitted to hospital. A nasopharyngeal swab PCR was done for him again and the result was negative also. Blood gases were normal. He had lymphocytosis (possibly due to TaibUVID effects) that counteract lymphopenia seen in COVID-19 patients. Biochemical and hematological evaluation were quite normal apart from increased serum chloride and lactate dehydrogenase. There was a mild decrease in serum CO 2 and alkaline phosphatase. Chest CT report revealed symmetrically inflated both lungs with non-specific focal nodular infiltrates (scattered in basal and medial lung segments) in left lower lobes with faint ground glass opacities. He was discharged home. Few days later, he was quite improved with no symptoms and returned to his work comfortably. In conclusion, TaibUVID nutritional supplements may be effective in rapidly changing the nasopharyngeal swab PCR from positive to negative. TaibUVID nutritional supplements are advisable as a natural, safe and effective prophylaxis to stop COVID-19 infectiousness, transmission and emergence of new cases. Clinical studies to investigate TaibUVID nutritional benefits are strongly recommended. TaibUVID may be promising and recommended for public prophylaxis to decrease emergence of new COVID-19 cases., Competing Interests: None., (AJBR Copyright © 2020.)

Thalassemia is a major health problem in affected children due to iron overload, increased oxidative stress, atherogenic lipid profile and tissue-damage. This study aims at investigating the cardioprotective and tissue-protective benefits of Al-hijamah and their impact on cell-mediated immunity for treating thalassemic children. This study aimed also at investigating the tissue-clearance principle of Taibah mechanism: whenever pathological substances are to be cleared from the human body, Al-hijamah is indicated. Al-hijamah was done to thalassemic children (15 males and 5 females having a mean age of 9.07 ± 4.26 years) using sterile disposable sets in a complete aseptic hospital environment. Prior ethical committee agreement (in addition to written patient's consents) was obtained from Tanta Faculty of Medicine, Egypt. Twenty thalassemic children received iron chelation therapy plus Al-hijamah for one session (30-60 minutes) versus an age and sex-matched thalassemic control group treated with iron chelation therapy only. Al-hijamah is a quite safe outpatient hematological procedure that significantly decreased serum cholesterol (from 129.75 ± 3.67 to 103.5 ± 4.18 mg/dl) and decreased serum triglycerides (from 109.25 ± 8.96 to 91.95 ± 7.22 mg/dl). Interestingly, Al-hijamah exerted significant tissue-protective effects (it decreased serum GPT from 98.65 ± 12.27 to 71.65 ± 32.78 U/L and serum GOT from 96.35 ± 14.33 to 69.35 ± 34.37 U/L). Al-hijamah-induced ferritin excretion caused decreased serum ferritin (high serum ferritin negatively correlated with cell mediated immunity). Al-hijamah exerted cardioprotective and tissue-protective and hypolipidemic effects. Al-hijamah decreased serum cholesterol and is cardioprotective for thalassemic patients as it protects against atherogenesis and atherosclerosis. Medical practice of Al-hijamah is strongly recommended in hospitals. Al-hijamah cleared blood significantly from causative pathological substances e.g. serum ferritin resulting in enhanced cell-mediated immunity (in agreement with the evidence-based Taibah mechanism)., Competing Interests: None., (AJBR Copyright © 2020.)

Objective: The aim of the current study was to introduce and measure the effectiveness of a new 3D-printed nasoalveolar molding (D-NAM) appliance on improving the maxillary arch dimensions (MADs) in infants with unilateral complete cleft lip and palate (UCLP) before surgical lip repair., Design: A prospective, balanced, randomized, parallel groups, single-blinded, controlled trial., Setting: All the steps of the current study were carried in the Department of Orthodontics, Cairo University in Egypt., Participants: Thirty-four, nonsyndromic infants with UCLP., Interventions: The eligible infants were randomly assigned into either no-treatment (control) or to the new D-NAM groups. In D-NAM group, the maxillary models were 3D scanned into virtual models onto which segmentation and alveolar segments approximation were performed. Approximation movements were divided into 3 models representing 3 activation steps. On each of these models, virtual appliance construction was performed followed by 3D printing of the appliance. Nasal stent was added manually to the appliances of the second and third steps. Horizontal tapes were applied to infants in the D-NAM group only., Main Outcomes Measures: A Blinded assessors carried all the MADs measurements virtually on digital models collected at the beginning (T1) and after (T2) treatment., Results: Clinically and/or statistically significant improvements in all the measured MADs were recorded in D-NAM group at T2 before surgical lip repair in comparison to control group., Conclusions: The introduced D-NAM/3D-printed appliance is a simple and efficient technique to improve the MADs in infants with UCLP before surgical lip repair.

Objective: The aim of the current randomized controlled trial (RCT) was to assess the effectiveness of taping alone in changing the maxillary arch dimensions (MADs) in infants with unilateral complete cleft lip and palate (UCLP) before surgical lip repair., Design: A prospective, balanced, randomized, parallel-group, single-blinded, controlled trial., Setting: All the steps of the current study were carried in the Department of Orthodontics, Cairo University in Egypt., Participants: Thirty-one, nonsyndromic infants with UCLP., Interventions: The eligible infants were randomly assigned to either no-treatment (control) or taping groups. In the taping group, all the infants received horizontal tape between the 2 labial segments aiming to decrease the cleft gap. No other interventions were performed to infants included in this group. Rubber base impressions were made to all the included infants in both groups at the beginning of the treatment (T1) and directly before surgical lip repair (T2). All the produced models were scanned using a desktop scanner producing digital models for outcome assessment., Main Outcomes Measures: A blinded assessor carried out all the MAD measurements virtually on the produced digital models at the beginning (T1) and after (T2) treatment., Results: Clinically and/or statistically significant changes in all the measured MADs were recorded in the taping group at T2 before surgical lip repair in comparison to the control group., Conclusions: It seems that taping alone is an efficient tool in changing the MADs before surgical lip repair in infants with UCLP.

Purpose: The aim of this prospective study was to determine whether there is a beneficial role of combining gonadotropin administration with testosterone downregulation in non-obstructive azoospermia patients prior to a second time microsurgical testicular sperm extraction after a negative one., Methods: A total of 40 non-obstructive azoospermia men were recruited from a specialized IVF center from 2014 to 2016. Participants were divided equally into two groups: Group A was subjected to testosterone downregulation alone for 1 month and then combined with gonadotropin administration for 3 months prior to second time testicular sperm extraction; Group B (controls) underwent second time microsurgical testicular sperm extraction without prior hormonal therapy., Results: Mean baseline follicle-stimulating hormone levels of the controls and the cases were 26.9 ± 11.8 and 25.4 ± 8.7, respectively. One month after testosterone downregulation, follicle-stimulating hormone level of the cases was normalized and became 2.4 ± 1.2. There was no statistically significant difference between baseline follicle-stimulating hormone levels of the controls and cases (p = 0.946). Remarkably, two cases were positive after downregulation (10%) and no controls were positive at second testicular sperm extraction (0%). There was no statistically significant difference between sperm retrieval after the second microsurgical testicular sperm extraction in the controls and the cases (p = 0.072)., Conclusion: Patients who underwent first time testicular sperm extraction with unfavorable outcome due to different techniques may benefit from testosterone downregulation combined with neoadjuvant gonadotropin administration as it had shown positive sperms retrieval in 2 out of the 20 cases, especially those with hypergonadotropic azoospermia.

Adjuvant nutritional treatment is a commonly overlooked topic when treating lethal viral diseases as COVID-19 pandemic. We recently introduced TaibUVID nutritional supplements (nigella sativa, chamomile and natural honey) as adjuvants for COVID-19 contacts, patients and public prophylaxis. TaibUVID Forte adds costus, senna and fennel to TaibUVID. Meta-analyses and systematic reviews confirmed evidence-based therapeutic benefits of TaibUVID components in treating many human diseases e.g. diabetes mellitus and hypertension, common co-morbidities in COVID-19 patients. Double-blind clinical trials for treating COVID-19 patients with TaibUVID supplements were inapplicable. In this retrospective study in Egypt, COVID-19 patients and contacts knew TaibUVID via social media and voluntarily used them. 65% of COVID-19 patients (n = 13) received both pharmacological treatments and adjuvant TaibUVID nutritional supplements. 35% (n = 7) received TaibUVID only. Lymphopenia rapidly improved to lymphocytosis upon regular TaibUVID intake. TaibUVID nutritional supplements helped COVID-19 contacts' prophylaxis. 70% of COVID-19 contacts (n = 14) (on regular TaibUVID intake) did not get SARS-COV2 infection. 30% (n = 6) were not using TaibUVID regularly and got mild flu-like symptoms and upon using both TaibUVID and pharmacological treatments, all improved and got negative nasopharyngeal swabs PCR. COVID-19 contacts were mainly physicians (40%, n = 8) (dealing with COVID-19 patients daily) and members of physicians' families (45%). Main presentations reported by COVID-19 patients (n = 20) were cough (90%), fever (55%), anosmia (45%), taste loss (45%), sore throat (45%), respiratory difficulty (45%) and malaise (35%). TaibUVID inhalation therapy (nigella sativa/anthemis/costus solution nebulization) was used by 65% of COVID-19 patients (n = 13) and alleviated respiratory manifestations e.g. cough and respiratory difficulty and was life-saving in some cases. 70% of COVID-19 patients (n = 14) improved in 1-4 days, 25% (n = 5) improved in 5-10 days while 5% improved in more than 10 days. TaibUVID nutritional supplements were tolerable and significantly satisfactory (P<0.01). 81.25% of COVID-19 patients (n = 13) did not report side effects. 18.25% (n = 3) reported mild diarrhea, sweating and hyperglycemia (not confirmed to be due to TaibUVID supplements). 31.25% of patients (n = 5) were satisfied by 100% with TaibUVID nutritional supplements. 37.5% (n = 6) of patients were satisfied by 75%. In conclusion, TaibUVID nutritional supplements are recommended for public prophylaxis (to decrease emergence of new cases) and treatment in COVID-19 pandemic. Clinical trials and further investigations are recommended., Competing Interests: None., (AJBR Copyright © 2020.)