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Modic changes (MC) have been proposed as a cause of low back pain (LBP). However, the proposition remains controversial. There is uncertainty over the existence or degree of association between the two and whether, if there is an association, it is a causal relationship. Previous systematic reviews of the evidence have had methodological flaws.The aim was to synthesize the current evidence to test the hypothesis that there is an association between MC and LBP and if there is, to evaluate the strength of the association.MEDLINE, EMBASE, and CINAHL were searched for all studies up to 31 December 2018 for cohort, case-control, and cross-sectional studies. Screening, quality assessment, and data extraction were conducted by two independent reviewers. Quality was assessed using the Joanna Biggs Institute tools for observational studies. The clinical heterogeneity among these studies ruled out pooling so a narrative review was undertaken.Fifteen studies met the inclusion criteria, varying in patient characteristics, characteristics of MC, coexisting spinal conditions, and outcomes. The quality of evidence was poor in six and moderate in seven. There was wide clinical heterogeneity amongst the studies. The inclusion ages varied from early teens to over 65s, pain duration varied from under 6 weeks to over three months, and characteristics of the MC chosen for the studies also differed. The results were inconsistent across the studies: the odds ratios varied from showing an inverse relationship [Kovacs] with an odds ratio 0.31 (95% confidence interval, 0.1-0.95) to a very strong positive association 121.4 (11.21-1315.08) [Nakamae]. There was no consistency in associations for: type of MC, lumbar levels affected, position in relation to the vertebra, and presence of co-existing spinal conditions. The associations were possibly spurious arising from potential biases suggested by incomplete reporting: publication bias, selective reporting, and post hoc analysis. Only one study at low risk of bias found a substantial association but it was a small study of a narrow group meaning its results may not be generalizable.The inconsistency of findings and the possibility that they were spurious means that no conclusions can be drawn about an association between MC and LBP. Future research should be designed as prospective cohort studies with adherence to reporting guidelines pertaining to observational studies and to MRI. Currently, clinicians should not look for the presence or absence of MC to guide their management of patients with LBP.

BACKGROUND: Subclinical hypothyroidism is diagnosed by increased level of serum thyroid-stimulating hormone (TSH) with normal levels of free triiodothyronine (FT3) and free thyroxine (FT4). Controversy exists concerning the early treatment of subclinical hypothyroidism with levothyroxine when TSH level is below 10 mIU/L. AIM: This stud aims to quantify the effects of a 3-month trial of levothyroxine replacement on quality of life in SCH patients with TSH level less than 10 mIU/L as primary outcome and fasting blood sugar and HbA1C levels as secondary outcome. METHODS: This was a randomized controlled trial. It was carried out on subjects between 18 and 65 years, of both sexes attending the family medicine outpatient clinic at Cairo University Hospitals with untreated symptomatic mild subclinical hypothyroidism. Simple randomization was performed by assigning random numbers from random number table. Quality of life (Short-Form 36 Questionnaire) as well as fasting blood sugar levels and HbA1C were assessed before the replacement of levothyroxine and 3 months after starting treatment in the subclinical hypothyroidism patients (intervention group) and were compared to the control group. RESULTS: The median of role limitations due to emotional problems, social functioning, and health change was higher in the intervention group in comparison with the control group. Moreover, the median scores of all general health questionnaire items showed significant positive statistical changes in the intervention group. There was also a significant improvement in glycemic control reflected in lower HbA1C levels and FBS. CONCLUSION: The results of our study highlight the positive effect of early substitution with levothyroxine in subclinical hypothyroid patients regarding the quality of life and glycemic control in Egypt and support the argument for replacement.

The newly emerging coronavirus disease 2019 (COVID-19) is characterized by multisystem inflammatory syndrome. The development of SARS-CoV-2 complications usually starts within few days following infection, and the severity of the disease determines its outcome. Vitamin D insufficiency is associated with risk of lung infections, also cell-based studies reported the ability of vitamin D to control enveloped virus growth. We aimed to investigate the relationship between the most eminent inflammatory biomarkers and the level of vitamin D aiming to provide a tool for early diagnosis and prediction of disease progression. The current study was approved by Research Ethics Committee (REC), Kasr Al-Ainy. After confirmation of being COVID-19 by PCR, the admitted patients were categorized as mild-moderate, and severe-critically ill based on clinical and radiologic data. The total levels of serum 25(OH)D, as well as other pro-inflammatory biomarkers were measured and were analyzed by receiver operating characteristic curve (ROC) analysis for detection of their association with COVID-19 disease severity and to determine their sensitivity and specificity at optimum cutoff points. The area under the curve (AUC) ROC for predicting COVID-19 disease severity was the highest (of 0.97) for vitamin D, inflammatory cytokines, liver enzymes, ferritin, and D-Dimer. In addition, high serum levels of creatinine, and elevated liver enzymes associated with severe-critical COVID-19. The low 25(OH)D was associated with the disease severity.

High-normal blood pressure (HNBP) has become associated with a 2-3-fold increase in the risk of developing hypertension. Cardiovascular diseases (CVDs) are independently linked to HNBP.To estimate the prevalence of HNBP, its predictors, and association with CVD risk among a country-representative sample of Egyptian adults.This study draws on data from the most recent Egyptian Health Issues Survey, and includes 13 983 adults aged 18-59 years. Sociodemographic data and anthropometric and blood pressure (BP) measurements were obtained, and the 10-year cardiovascular risk score was calculated using World Health Organization CVD risk charts for participants aged ≥ 40 years.Overall, 15.31% and 21.0% of the study population had HNBP and hypertension, respectively. Compared to people aged 18-30 years, the odds of HNBP were 1.36, 1.67 and 2.39 among those aged 31-40, 41-50 and 51-59 years, respectively. The odds of HNBP were higher among male, overweight and obese adults, and patients with diabetes. The odds of HNBP and hypertension were higher among participants with high WHO CVD risk than those with low WHO CVD risk.HNBP is an alarming risk factor among Egyptian adults because it is strongly associated with CVD risk. Policy-makers should devise long-term, effective strategies for its prevention and control.معدل انتشار ومحدِّدات ضغط الدم الطبيعي، وضغط الدم فوق الطبيعي، وارتفاع ضغط الدم، وارتباط ذلك بمخاطر الإصابة بأمراض القلب والأوعية الدموية في مصر.سمر فارس، سعيد سليمان.أصبح ضغط الدم فوق الطبيعي مرتبطًا بحدوث زيادة في خطر الإصابة بأمراض القلب والأوعية الدموية بمقدار ضعفين إلى ثلاثة أضعاف. وترتبط أمراض القلب والأوعية الدموية ارتباطًا مستقلًّ بضغط الدم فوق الطبيعي.هدفت هذه الدراسة إلى تقدير معدل انتشار ضغط الدم فوق الطبيعي، والعوامل المنبئة به، وارتباطه بخطر الإصابة بأمراض القلب والأوعية الدموية في عينة قُطرية مُثِّلة للبالغين المصريين.كان ذلك تحليلً مقطعياً لمسح المشكلات الصحية في مصر لعام 2015. وشمل التحليل 13983 من البالغين تتراوح أعمارهم بين 18 و 59 عامًا. وجُِعت البيانات الاجتماعية والسكانية، والقياسات البشرية، وقياسات ضغط الدم، واحْتُسِبت درجة خطورة أمراض القلب والأوعية الدموية على مقياس مكون من 10 سنوات باستخدام مخططات منظمة الصحة العالمية لخطر أمراض القلب والأوعية للمشاركين الذين تبلغ أعمارهم 40 عامًا فأكثر.بوجه عام، تبيَّ أن 15.31 ٪ و 21 ٪ من السكان المشمولين بالدراسة يعانون من ضغط الدم فوق الطبيعي وارتفاع ضغط الدم، على التوالي. وبالمقارنة بالأشخاص الذين تتراوح أعمارهم بين 18 و 30 عامًا، بلغت احتمالات الإصابة بضغط الدم فوق الطبيعي 1.36 ، و 1.67 ، و 2.39 في صفوف الذين تتراوح أعمارهم بين 31 - 40 ، و 41 - 50 ، و 51 - 59 عامًا، على التوالي. وكانت احتمالات الإصابة بضغط الدم فوق الطبيعي أعلى في صفوف الذكور، والبالغين الذين يعانون من زيادة الوزن والسمنة، ومرضى السكريّ. وكانت احتمالات الإصابة بضغط الدم فوق الطبيعي وارتفاع ضغط الدم أعلى في صفوف المشاركين الذين سجلوا ارتفاعًا في خطر الإصابة بأمراض القلب والأوعية الدموية، وفقًا لمخططات منظمة الصحة العالمية، مقارنةً بالمشاركين الذين سجلوا انخفاضًا في خطر الإصابة بأمراض القلب والأوعية الدموية وفقًا لمخططات منظمة الصحة العالمية.يُعَدُّ ضغط الدم فوق الطبيعي أحد العوامل المُنذِرة بالخطر في صفوف البالغين المصريين، نظرًا لارتباطه القوي بخطر الإصابة بأمراض القلب والأوعية الدموية. وينبغي أن يضع راسمو السياسات استراتيجيات طويلة الأجل وفعالة للوقاية من ضغط الدم فوق الطبيعي ومكافحته.Prévalence et déterminants de la pression artérielle normale, normale haute et de l'hypertension et association avec le risque cardiovasculaire en Égypte.La pression artérielle normale haute est désormais associée à un risque deux à trois fois plus élevé de développer une hypertension. Les maladies cardiovasculaires (MCV) sont indépendamment liées à la pression artérielle normale haute.Estimer la prévalence de la pression artérielle normale haute, ses facteurs prédictifs et l'association avec le risque de MCV dans un échantillon d'adultes égyptiens représentatif du pays.La présente étude s'appuie sur les données de la plus récente enquête égyptienne sur les problèmes de la santé, et inclut 13 983 adultes âgés de 18 à 59 ans. Des données sociodémographiques et des mesures anthropométriques ainsi que des mesures de la pression artérielle ont été obtenues, et le score de risque cardiovasculaire à 10 ans a été calculé à l'aide des tableaux de risque de MCV de l'Organisation mondiale de la Santé pour les participants âgés de 40 ans et plus.Au total, 15,31 % et 21 % de la population de l'étude présentaient respectivement une pression artérielle normale haute et une hypertension. Par rapport aux personnes âgées de 18 à 30 ans, les risques liés à une pression artérielle normale haute étaient de 1,36, 1,67 et 2,39 respectivement chez les personnes âgées de 31 à 40 ans, 41 à 50 ans et 51 à 59 ans. Les risques liés à une pression artérielle normale haute étaient plus élevés chez les hommes, les adultes en surpoids et obèses et les patients diabétiques. Les risques liés à une pression artérielle normale haute et une hypertension étaient plus élevés chez les participants présentant un risque de MCV élevé selon l'OMS que chez ceux présentant un faible risque.La pression artérielle normale haute est un facteur de risque alarmant chez les adultes égyptiens car elle est fortement associée au risque de maladie cardiovasculaire. Les responsables de l'élaboration des politiques doivent concevoir des stratégies efficaces à long terme pour prévenir et maîtriser cette maladie.

Introduction: Radiotherapy is an important therapeutic manner of a wide range of tumors. Its side effects on normal cells limit the efficiency of therapy.Aim of the work: To evaluate the protective role of daidzein and/or vitamin C against biochemical, histopathological and ultrastructural changes in male albino rats exposed to gamma radiation (γ-radiation).Materials and Methods: The whole-body exposed to 8 GY γ-radiation. Daidzein was given to rats at a concentration of 63 mg/kg b.wt./day for 7 days before irradiation and 7 days during exposure. Whereas vitamin C was ingested at a concentration of 5 mg/kg b.wt. /day for 7 days before irradiation and 7 days during exposure. Animals were sacrificed on the 1st day post the irradiation dose. Blood samples were collected for biochemical determination of uric acid, urea, and creatinine. Lipid peroxides (TBARS) concentration and the activities of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) were also measured. Samples from the kidney were processed for light and electron microscopy.Results: Irradiation induced significant elevation in uric acid, urea, creatinine and TBARS. These changes were accompanied by significant decrease in antioxidant status (SOD, CAT, and GPx). Also, the histological and ultrastructural investigation displayed remarkable changes in kidney tissue. Daidzein and /or vitamin C reduced the kidney damage induced by irradiation; this was showed by declined levels of creatinine, urea and uric acid, in addition to increased CAT, GPx, and SOD activities. The histopathological structure and ultrastructural alternations were also improved. The radioprotection index for the combination of daidzein and vitamin C was found to be more than daidzein or vitamin C separately. Conclusion: Daidzein and vitamin C might modulate radiation damages to kidney by boosting the antioxidant capacity and attenuating oxidative injury.