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Background SARS-CoV-2, was identified as a global pandemic by the World Health Organization a few months after the first epidemic. It penetrates host cells through angiotensin-converting enzyme 2 receptors and spreads by respiratory droplets. Testes are among the several tissues that have high expression levels of ACE-2 receptors. The current study aimed to evaluate the hypothalamic-pituitary-testicular axis integrity among Egyptian post-COVID-19 patients.Methods This is a cross-sectional study that included patients with a history of COVID-19 infection, at least 3 months from the onset of COVID-19. A detailed clinical history was obtained, and a thorough examination was performed. Laboratory tests included FBG, total testosterone, free testosterone, bioactive testosterone, FSH, LH, prolactin, E2, albumin, and SHBG. Testicular ultrasonography was performed. The data were statistically analyzed.Results Eighty male patients were evaluated with a mean age of 35.53 ± 10.35 years. The mean serum total testosterone was 5.48 ± 1.65 ng/ml. Low testosterone was detected in 2.8% of the patients. High LH levels were detected in 17/80 patients (21.3%). High FSH levels were detected in 4/80 patients (5%). Six patients had elevated serum E2 level. The mean serum prolactin value was 10.90 ± 5.66 ng/ml. Fourteen patients had elevated prolactin levels. The mean serum T/LH ratio was 3.28 ± 1.52. The ratio of T/LH was decreased in eight COVID-19 patients (10%). In COVID-19 patients, a statistically significant negative correlation was found between age and free testosterone (FT) (r=-0.381, p

Abstract Background The COVID-19 outbreak has increased awareness of vitamin D's (Vit-D) potential advantages for both prevention and treatment. Adequate vitamin D levels are necessary for health of the immune system, which can help with cellular response and protection against the severity of microbial infection. Purpose To evaluate Vit-D levels and their association with illness severity in Egyptian COVID-19-infected individuals. Methods This case–control investigation was performed at the Alexandria Main University Hospital on 80 subjects divided into 2 groups: 40 COVID-19 patients and 40 healthy persons to measure the Vit-D levels of the Egyptian cohort. Results There was a statistically insignificant difference in the Vit-D serum levels of the studied groups (P = 1.000). The age of the Vit-D insufficient patients was significantly higher than that of Vit-D sufficient patients (P = 0.006). There was a statistically insignificant rise in the CRP level in the Vit-D insufficient patients (P = 0.862) compared to patients with sufficient Vit-D. Also, the D-dimer levels in Vit-D-insufficient patients were considerably higher (P = 0.015). Patients with sufficient Vit-D exhibited significantly lower levels of IL-6 than Vit-D insufficient patients. (P = 0.037). Patients in the Vit-D-insufficient subgroup needed substantially more breathing support than those in the Vit-D-sufficient group (P = 0.020). Conclusion Although there was no association between both levels of Vit-D and the COVID-19 infection risk, insufficiency of Vit-D was related to more severe infection.

Abstract Background Congenital adrenal hyperplasia (CAH) is a common cause of urogenital sinus (UGS) anomalies. Delineating the abnormal anatomy of the UGS is crucial prior to the operative repair. Genitography and cystourethroscopy are commonly used by most surgeons to plan for reconstruction. We aim at this study to evaluate the role of these modalities and to compare their accuracy in delineating the abnormal anatomy. Methods We did a prospective study of 30 female paediatric patients with persistent UGS secondary to CAH. All cases were evaluated with genitography and cystourethroscopy. We compared the accuracy of each modality in delineating the confluence. The confluence depth, the urethral length proximal to the confluence, the vaginal dimensions, and the depth of the bladder neck were measured in the genitograms. Results Cystourethroscopy showed the abnormal anatomy in all 30 cases (100%). The genitogram showed the site of confluence in 24 cases out of 30 cases (80%). According to the site of the vaginal opening in relation to the external urethral sphincter in the genitogram, we had 2 groups: the low confluence group (N = 14) and the high confluence group (N = 16). The mean confluence depth in the low group was 9.8 mm vs. 20.5 mm in the high group (p-value / = 0.63 mm low) (p-value / = 0.63 mm) and high (

This investigation was carried out to examine the safety and microbiological quality of products made from meat, dairy and vegetables. Samples of frozen food were examined for the presence of Gram-negative bacteria. A total of 49 frozen food samples were collected, including chicken nuggets, chicken fillets, chicken sticks, breaded breast chicken, fish, beef burger and minced beef roll, white cheese, camembert cheese, and vegetables (okra and green peas). Standard methods were used to determine the diversity of bacterial isolates in various food samples. About 182 isolates of Escherichia coli, 63 isolates of Salmonella typhi, 51 isolates of Pseudomonas, and 63 isolates of Klebsiella were recovered from the various frozen food samples. Meat samples showed a high prevalence of E. coli and Pseudomonas. The antibiotic susceptibility patterns of the isolated bacterial strains were also examined. Out of 12 antibiotics, only ciprofloxacin and ofloxacin showed a high level of susceptibility. According to the study’s findings, the majority of the frozen meat product samples contained a significant number of bacteria and were therefore unsafe for human consumption. These microorganisms can cause infection and are therefore associated with a high risk to the consumers. Therefore, it is important to pay attention to health and education issues in relation to food safety.

Abstract Objectives Phonological development is dependent on the integrity of the auditory system. Otitis media with effusion (OME) may affect speech perception in children and therefore phonological development. The aim of this study was to investigate the impact of persistent OME on the phonological performance of preschool children. Methods Sixty children with persistent OME who were candidates for myringotomy and ventilation tube insertion were included in this prospective observational study. We assessed their phonological skills before and after surgery (3 and 6 months) by phonological production tasks that included calculation of percentage of consonants correct (PCC) and process density index (PDI). Results We detected preoperative poor phonological performance in 91.7% of children. We found statistically significant differences in PCC and PDI between the three time periods. Also, there was a significant improvement after 6 months compared to 3 months. Conclusions OME has an adverse consequence on the phonological performance of preschool children, it can affect different domains such as PCC and PDI. The findings of this study revealed that myringotomy with ventilation tube insertion for children with persistent OME could aid in the development of intact phonological skills.

ABSTRACTBackground Vitamin B12 is a micronutrient required for hematopoietic, neuro-cognitive and cardiovascular function. Biochemical and clinical vitamin B12 deficiency has been recognized in patients with type 2 diabetes mellitus. One of the adverse effects of long-term metformin use is vitamin B12 malabsorption. Aim of the study was to assess the state of vitamin B12 deficiency in people with type 2 diabetes and to ascertain the relationship between vitamin B12 status, metformin use and peripheral neuropathy. It is a retrospective study that was conducted on 8040 subjects included 2126 type 2 diabetic patients, and 5914 nondiabetic individuals. Personal information, medical history, including metformin and multivitamin therapy use as well as the existence of clinical peripheral neuropathy, were all included data. For the purpose of measuring the amount of vitamin B12, blood samples were taken. Serum B12 levels

Objective:Hypotension is the most frequent side effect of intrathecal anaesthesia, with an incidence of more than 80%. Following neuraxial anaesthesia, perioperative shivering is a serious complication affecting 40-60% of patients undergoing surgery. This study aimed to determine the effectiveness of low-dose ketamine on blood pressure in patients undergoing cesarean delivery after spinal anaesthesia.Methods:We included 126 female patients undergoing cesarean deliveries, American Society of Anesthesiologists (ASA)-(II and III), and aged 21-40 selected from the outpatient clinics of the anaesthesia department. Patients were randomized to two groups; Group K (63 patients), who received 0.3 mg kg-1 of ketamine IV diluted to 10 mL, followed by an infusion of 0.1 mg kg-1 h-1. Group C (Controlled) (63 patients) received 10 mL of normal saline, followed by an infusion of 0.1 mL kg-1 h-1, which started before spinal anaesthesia.Results:Compared with the saline group, the average heart rate, blood pressure, and level of sedation were significantly higher in the ketamine group (P < 0.05). The ketamine group reported a significantly lower incidence of shivering (P < 0.01). The ketamine groups exhibited significantly less mild or severe hypotension (P < 0.05). There was no significant difference between the two groups in terms of nystagmus, diplopia, hallucinations, or neonatal outcomes (P > 0.05).Conclusion:Ketamine decreases the incidence of hypotension and shivering in patients undergoing spinal anaesthesia during cesarean delivery. In addition, it resulted in improved sedation for the mother and prolonged postoperative analgesia without neonatal illness.

Kojic acid (KA) is a multipurpose natural compound, commonly used in the food and cosmetics industry. It is produced by different types of molds especially by the species Aspergillus oryzae. In this study, we test the mutagenicity of local produced kojic acid PKA produced by the wild-type strain of A. oryzae as well as the standard commercially produced kojic acid SKA and ascorbic acid SAA for comparison to stop food manufacturers doubts about using KA. AMES test with Salmonella enterica ATCC 29629 strain TA1535 and S9 liver enzyme for metabolic activation of the tested compounds were utilized in this study by direct and indirect methods were used in the test. The study results showed that the tested PKA kojic acid had cannot induce reverse mutation in the strain ATCC 29629TA1535 used in the test in contrast with the positive control in direct and indirect methods, even where the tested acids were treated with S9 liver enzymes with or without pre-incubation for three hours at 37 °C hadn’t given positive results on TA1535. The used concentration of 1% and 10% S9 liver enzymes hadn’t metabolically activated the three acids. 6 mg/plate of KA inhibited the growth of TA1535. SAA gave the same negative results as PKA and SKA. In conclusion, the tested PKA produced by wild-type A. oryzae was not has mutagenic effect on bacterial strain TA1535 and gave the same effect as the commonly used as food additive SAA and SKA even when treated with S9 liver enzymes.

Abstract The debate about which surgical technique for tonsillectomy could be superior over another is continuous. Tonsillectomy techniques are classified into cold and hot procedures. In cold techniques, no heat is used; they include dissection, guillotine, microdebrider, harmonic scalpel, and cryosurgery. Hot techniques include electrocautery, coblation, radio frequency, and laser. In Egypt, the used methods are cold dissection, electrocautery, cold dissection with electrocautery hemostasis, coblation, and less commonly laser. In this study, we described the advantages and disadvantages of each technique. Hot techniques have shorter operative time and less intraoperative bleeding, while cold dissection technique has less postoperative pain and less postoperative complications especially secondary hemorrhage, with more rapid wound healing. However, coblation technique may have less pain in the first few hours postoperatively relative to cold technique. Electrocautery technique is the most painful method with delayed wound healing. Laser technique is nearly equivalent to electrocautery with slightly less pain. Cold dissection technique is less costly when compared to other techniques. Family satisfaction after tonsillectomy is dependent mainly on less postoperative pain and rapid recovery. Cold dissection is still considered the gold standard technique. Caution should be taken on using hot techniques especially when used for dissection, and the trainee surgeons should become familiar with cold dissection before shifting to other tonsillectomy techniques. From this study, we can say that hot techniques should not be used except after mastering the cold dissection tonsillectomy; also, the new advanced techniques can be reserved for high-risk patients such as having bleeding disorders.

Background & Aims: The coronavirus disease 2019 (COVID-19) outbreak has become a global public health pandemic, and many deaths occurred in a short period. It is possible for coronaviruses to cause hepatic injury, and the dying patient may complain about it. Aim of this study was to compare the liver function parameters, and demographic, clinical, and laboratory results between survivors and non-survivors of COVID-19. Materials & Methods: This was a retrospective-prospective cohort study conducted at Universal Hospital in Sudan. The Study included 80 cases of coronaviruse infected patients, of them 43 (53.7%) were female and 37 (46.3%) were male. A structured questionnaire was used to collect demographic, clinical, and results of liver function tests on the first day of admission. Patients were divided into survivors (treated and discharged) and non-survivors (died) groups, according to their outcomes. The analysis of the questionnaire was done using SPSS version 25. Results: Out of the 80 coronaviruse infected patients, 35 (43.8%) were survivors while the remaining 45 (56.2%) were non-survivors. The results revealed a significant increase in the mean levels of AST (p. value= 0.001), ALT (p. value= 0.047), and decreased levels of Albumin (p. value= 0.009) in the Non-survivor group compared to the survivors' group. The regression analysis demonstrated a significant correlation between AST (p value =0.04) and albumin (p value=0.02) with COVID-19 death. In the Receiver Operation Curve (ROC) analysis, the Area Under the Curve (AUC) value of the AST was 0.70 (p=0.002) with sensitivity and specificity of 73% and 66%, respectively. Conclusion: The Study concluded that baseline AST level was significantly correlated with the mortality of COVID-19 patients.

Abstract Background Nutritional support is essential as enteral or parenteral nutrition to reduce catabolism, to lower the complications rate, and to improve outcomes in critically ill patients. Results The median, range age of the cohort was (median 10, range 6–18.8 months). One-hundred thirteen (62.8%) were males, and 67 (37.2%) were females. The higher frequency of sepsis, ventilator-acquired pneumonia (VAP), and mortality founded in the group received PN. Frequency of sepsis was 15 (16.7%), VAP was 5 (5.6%), and the mortality rate was 11.1% in EN group, while frequency of sepsis was 37 (41.1%), VAP was 23 (25.6%), and the mortality rate was 27.8% in PN group (P = 0.001, 0.001, 0.01, respectively). Median of weight gain on the EN group was 0.17 kg at 2nd week which was more than those in PN group (P = 0.001). The mean ± SD time for reaching the caloric target for those receiving early EN was 4.0 ± 1.9 days which is earlier than that of PN group (6.2 ± 1.7 days) (P = 0.001). There is no significant difference between both groups as regard pediatric intensive care unit (PICU) stay length and mechanical ventilation stay length. Conclusion Early EN remains the preferred route for nutrient delivery as the PN route was accompanied by a lot of complication such as sepsis, VAP, and high mortality rate.

Background: Fluids are an integral line of management of septic shock as circulatory instability and myocardial dysfunction are the major causes of death in septic shock. Several indicators of fluid responsiveness (FR) have been proposed. Aim of the Work: to assess predictive value of assessment of fluid responsiveness on outcome of children with sepsis. Methods: This study was a prospective observational cohort study which was conducted on 25 children who were admitted to Pediatric Intensive Care Unit with septic shock at Children Hospital, Cairo University from February 2020 to May 2020. All underwent bedside echocardiography assessment of fluid responsiveness (FR) using inferior vena cava’s (IVC) diameter: distensibility, collapsibility, variability indices and time velocity integral across aortic valve before and after fluid resuscitation. Results: The mean age ± SD of the studied cohort was 33.72 ± 39.65 months, 17 (68%) were males and 8 (32%) were females. All patients presented by septic shock, of them 13 (52%) were fluid responsive and 12(48%) were fluid nonresponsive (p=0.118). FR was different between ventilated patients and non-ventilated patients as regards IVC variability % before and after IV fluids (p= 0.001) and (p=0.001) respectively, stroke volume and cardiac output after IV fluids (p =0.033) and (p=0.001) respectively. FR correlated with central venous pressure measurements (p=0.000017) and inotropic support (p=0.0074) but not with main diagnosis of septic shock, mechanical ventilation of patients or not and not with number of system failure. Ten (40%) of them were on mechanical ventilation and inotropes. Nineteen (76%) improved and 6 (24%) died. There was no correlation between FR and outcome (p= 0.316). Conclusion: Bedside echocardiography may be a useful non-invasive method for follow up, evaluation of fluid responsiveness in children septic shock and to assess CI which helps in assessment of fluid response, make decision on medication, and help evaluate the different forms of shock, but it has no significant relation to the outcome of these children. Outcome of septic shock is multifactorial, depends on timing of diagnosis, fluid administration, inotropic support, and cardiac condition not fluid responsiveness only.

Background: Extubation failure is failure to maintain normal spontaneous breathing after a period of mechanical ventilation with the need for reintubation within 24–72 hours. It has multiple risk factors such as deconditioned muscles, upper airway edema and others. Aim of the Work: To study the frequency and causes of extubation failure in mechanically ventilated children. Patients and Methods: This is an observational prospective study that included all admitted children in Pediatric Intensive Care Unit (PICU), Cairo University Children Hospital who underwent mechanical ventilation (MV) through ETT for more than 48 hours (145 child) with Glasgow coma scale above 8. They were subdivided into successfully extubated (78 children) and failed extubation (67 children). Results: The mean ± SD age of the cohort was 13.5 ± 15.15 months (range1.3-48, median= 8 months). Of them 80 (55.17%) were males, and 65 (44.8%) were females. The commonest underlying diagnosis was pneumonia in 38 (26.2%), bronchial asthma in 32 (22%), encephalopathy in 32 (22%), and aspiration in 11 (7.58%). Failed extubation was encountered in 67 (46.2%) children. The encountered risk factors of extubation failure were: sedation in 12 (16.7%) (p=0.001), excessive tracheal secretion of more than 200 ml /24 h in 14 (18.7%) (p=0.03), accidental extubation in 27 (40.3%) (p=0.01) and the need for higher setting on MV in all 67 children with failed extubation. Among failed extubated patients, the mean± SD for PIP, PEEP, and FiO2 were 14.5± 1.8 /cm H2O, 5.5± 0.5/cm H2O, and 27.5± 6.1% respectively. While, PIP, PEEP, and FiO2 in the successfully extubated group were 12.8± 1.6 /cm H2O, 4.1± 0.4/cm H2O, and 24.8± 5.3%, (p= 0.01, p=0.001 and p= 0.001) respectively. Patients who underwent gradual withdrawal of ventilatory support had a higher frequency of successful extubation than those extubated accidentally (p= 0.01). Sensitivity, and specificity of above mentioned indices for successful extubation were 53.79%, and 28.72% respectively. Conclusion: Causes of extubation failure are the need for long duration of sedation, excessive tracheal secretion, and need for high setting on MV. Furthermore, gradual weaning decreases the frequency of extubation failure. There is a need for a more sensitive and specific comprehensive objective indicator(s) for successful timely extubation.

Background:Chemotherapy-caused nausea and vomiting is a health problem in cancer patients. Olanzapine is used with serotonin receptor antagonists plus dexamethasone post Neurokinin 1 receptor antagonists as the antiemetic. Objective: The study aimed to determine the efficacy of (5 and 10) mg of olanzapine with antiemetic drugs against chemotherapy-induced nausea and vomiting. Methods: The study groups are Group S: received triple antiemetic therapy aprepitant at (1-3) day, dexamethasone at (1-4) day, and ondansetron only on the first day. Group O5: received olanzapine 5 mg with triple antiemetic therapy aprepitant (1-3) days, dexamethasone (1-4) day, ondansetron the first day, and olanzapine 5 mg (1-4) days. Group O10: received (olanzapine 10 mg with triple antiemetic therapy) aprepitant (1-3) days, dexamethasone (1-4) days, ondansetron day 1, and olanzapine 10 mg (1-4) days. The cancer was diagnosed by mamograph; the MAT score was used to control chemotherapy-caused nausea and vomiting. Results: Higher acute and delayed nausea was observed in group S than in groups O5 and O10. Overall, nausea control was increased in group S than in groups O5 and O10. There was no significant difference between the different study groups. Conclusion: Olanzapine 5 mg and 10 mg could treat nausea more than triple antiemetic in patients with nausea.

Background: Candida auris is an emerging multidrug-resistant fungal pathogen that represents a current serious threat to healthcare settings. Objective: The objective was to determine the prevalence of C. auris in a Riyadh hospital since its initial detection in late 2019. Methods: Using an adapted risk assessment tool, we reviewed the charts and medical files of all suspected and confirmed cases of C. auris infections reported at King Khalid University Hospital, Riyadh, between November 2019 and December 2022. Anonymized data were retrieved in a pre-established datasheet and analyzed to determine the epidemiological characteristics of C. auris infections in our facility. We analyzed prevalence by age, gender, risk factors, and according to sampling source. Results: Of the 53 confirmed C. auris-positive cases during the study period, 33 (62%) were males. Their ages ranged between 15 and 98, with most positive cases occurring in those aged 50 and above. Only one of the confirmed cases was hospital-acquired. All patients had at least one risk factor, and urine samples yielded the greatest number of positive cases, while admission to healthcare facilities constituted the highest risk in our study. Conclusion: Establishing a local prevalence pattern could serve as a baseline/benchmark to compare with regional and international benchmarks.

Abstract Background Periodic limb movements during sleep (PLMS) and obstructive sleep apnea syndrome (OSAS) are two frequent coincident sleep disorders. The association of PLMS with OSAS severity and predictors of PLMS in OSAS patients were investigated. Material and method This is a retrospective study that enrolled adult patients ≥ 16 years old who visited the sleep unit at Mouwasat Hospital, Saudi Arabia, between January 2021 and October 2021. All were subjected to full medical history, clinical examination, Epworth Sleepiness (ESS), STOP-Bang questionnaires, and standard overnight polysomnography. Subjects were subdivided into two groups based on PSG findings: group I, OSA patients (153). Patients were classified into mild n = 57 (AHI ≥ 5 and

Although hepatitis E virus (HEV) infection has been widely understood as a public health concern in pregnant females, it is sometimes overlooked because of unusual observations of hepatitis E-induced complications during pregnancy. The objective of this descriptive cross-sectional study was to find out how frequent Hepatitis E virus infection is in pregnant women in Sudan. Blood samples were collected from pregnant women (n = 90) attending Khartoum North Hospital from February to December 2019. The specimens were investigated for Hepatitis E virus IgG and IgM antibodies using the commercial kits based on the enzyme immunosorbent assay (ELISA) technique. Out of ninety pregnant women, 36 (40%) were found positive for IgG antibodies, and 5 (6%) were tested positive for IgM antibodies. In addition, 13 (14.5%) of the positive cases are women in their third trimester. These data showed a significant association between previous Hepatitis E virus infection and miscarriage (p

In response to Egypt's escalating water scarcity and pollution, Riverbank Filtration (RBF) technology is emerging as an effective solution to enhance water quality and simplify drinking water provision. This study evaluates RBF at three sites in Upper Egypt by assessing hydrogeological conditions and water quality based on 36 parameters from 2022 to 2023. Findings indicate that RBF efficiently treats infiltrated river water, with all sites meeting turbidity and microbiological standards (Total Bacterial Count and Coliforms), achieving removal rates of approximately 90% and 99%, respectively. Despite these successes, challenges persist in reducing manganese to safe levels, with concentrations at Alsaayda site reaching 0.51 mg/L, over the drinking water safe limit of 0.4 mg/L. To address this, further post-treatment strategies are proposed to remove the excess manganese. A practical application of an Oxidizer at the Bani Murr groundwater treatment plant has demonstrated the effective removal of iron and manganese, bringing their levels down to safe drinking water standards. This case exemplifies a successful solution for iron and manganese removal. This research highlights RBF's potential in water treatment in developing countries, while emphasizing the need for supplementary measures to manage specific contaminants. [ABSTRACT FROM AUTHOR]

Acne vulgaris is one of the most common chronic inflammatory skin disorder affecting millions of people worldwide. Vitamin D deficiency has a role in various inflammatory skin diseases as acne. This study aimed to investigate the serum level of 25 hydroxy vitamin D in acne patients and to assess the efficacy and safety of active vitamin D in management of acne. This study was conducted on 100 patients with acne and 100 healthy controls, then the 100 acne patients were randomized to either the study group that received 0.25ug alfacalcidol daily or the placebo group that received oral placebo during the 3 months study period. Serum levels of 25-hydroxy-vitamin D were significantly lower in acne patients than in healthy control and were inversely correlated to the severity of acne. After alfacalcidol administration, the study group showed significant higher level of 25(OH) D levels (p