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Abstract This paper presents NN_ILEACH, a novel neural network-based routing protocol designed to enhance the energy efficiency and longevity of Wireless Sensor Networks (WSNs). By integrating the Energy Hole Removing Mechanism (EHORM) with a sophisticated neural network for cluster head selection, NN_ILEACH effectively addresses the energy depletion challenges associated with traditional protocols like LEACH and ILEACH. Our extensive simulations demonstrate that NN_ILEACH significantly outperforms these classical protocols. Specifically, NN_ILEACH extends the network lifetime to an impressive 11,361 rounds, compared to only 505 rounds achieved by LEACH under identical conditions—representing a more than 20-fold improvement. Additionally, NN_ILEACH achieves a 30% increase in throughput and a 25% enhancement in packet delivery ratio, while reducing overall energy consumption by 40%. These results underscore the protocol’s potential to optimize energy usage and maintain network stability, paving the way for more resilient IoT systems in dynamic environments. Future work will explore further integration of machine learning techniques to enhance adaptability and performance in WSNs.

Background: Medical education is known to be stressful and demanding. Medical students face a various stressors, which include academic pressure, fear of not reaching goals, and difficulty integrating into systems. This study aims to assess levels of stress and coping strategies among medical students at Jazan University in Saudia Arabia. Materials and Methods: A descriptive cross-sectional study was conducted that comprised of 240 students at Jazan Faculty of Medicine using a self-administrated questionnaire to obtain data on socio-demographic characteristics, perceived stress, stressors, and coping strategies. Results: Respondents mean age was 22.08 ± 1.82 years and 52.7% were female. Of these, 51.9% were in preclinical years of study, 29.5% were in the second academic year, and 39.8% had a GPA greater than 4. Students stress level ranges from moderate to high. The most common causes were academic problems and frequency of examinations and work overload (92.1%), worrying about the future (61.8%), and lack of entertainment and time for recreation (58.9%). The most common coping strategy was recreational activity such as going to movies, watching TV, reading, sleeping, or shopping (36.5%). Mean perceived stress scale (PSS) and Brief-COPE scores were 24.1 ± 4.85 and 66.16 ± 10.71, respectively. Participant age and PSS score have significant positive correlation (P < 0.05). Conclusion: Stress level is moderate to high especially among students in preclinical years and among females. It is recommended to improve teaching and learning environment plus proper counseling and academic support. Also, active involvement of students in the educational process may help reduce academic stressors. Plain Language Summery: Medical students face a range of stressors due to the demands of study. This research found medical Students suffer stress level ranging from moderate to high. Most common causes of stress are academic problems, frequency of examinations, and work overload. Most common coping strategy performed by students was recreational activities like going to movies, watching TV, reading, sleeping, or shopping. It is recommended to improve teaching and learning environment plus proper counseling and academic support. Also, active involvement of students in the educational process may help reduce academic stressors.

Background Coronavirus disease 2019 (COVID-19) is a severe infectious disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Regarding the ongoing spread of COVID-19 in Egypt, this study aimed to determine the sensitivity and specificity of rapid COVID antigen swab in the diagnosis of COVID-19 infection in pulmonary and extrapulmonary manifestations of COVID-19 and discuss the pulmonary and extrapulmonary symptoms of COVID-19. Patients and methods This is a cross-sectional study performed on 447 patients diagnosed with COVID-19 at the chest out-patient clinic or Department of Chest and ICU in Menoufia University Hospital during the period from July 2021 to March 2022. Detailed history, full laboratory data, high-resolution computed tomography, and rapid antigen swab were obtained. Results A total of 447 patients were included in this study. They were classified into two groups: group 1 included 105 patients with pulmonary symptoms and group 2 included 342 patients with extrapulmonary symptoms in the absence or presence of pulmonary symptoms. The current study showed a sensitivity of 88.6% and specificity of 100% regarding the rapid antigen swab in diagnosing COVID-19. Regarding the extrapulmonary symptoms, muscle ache was the most common symptom in 52% of the patients followed by loss of taste and smell in 39.8% of patients. Conclusion Rapid antigen tests are practical, are reliable, provide fast results (~15 min), and are cheap diagnostic methods with high sensitivity and specificity for COVID-19. Moreover, it showed a wide range of extrapulmonary symptoms of COVID-19, and every symptom revealed should be suspected and investigated.

The incredibly increasing demand for higher rates in the last decade as well as the introduction of many new applications that require wireless connectivity necessitate proper and efficient utilization of the frequency spectrum. During the last decade, the concept of cognitive radio has been introduced and extensively researched as a possible solution for telecommunication operators to increase the use of the spectrum, which is usually under-utilized. In this paper, the problem of dynamic spectrum allocation is discussed. A new mathematical formulation is proposed for the dynamic spectrum allocation problem. The new formulation defines a bi-objective function that considers the maximization of both the total system throughput and the number of active users. The proposed formulation is solved optimally using the branch and bound algorithm with a linear programming solver at its core. In addition, two novel heuristic algorithms are proposed for use instead to alleviate the time complexity of the branch and bound algorithm. Simulations show that although sub-optimal, the solutions obtained by the proposed algorithms are at least 80% of the optimum solution obtained by the branch and bound algorithm, with the advantage of significantly shorter time.

Background Pleural effusion is a common clinical problem and can arise from many diseases. Several imaging methods such as chest radiograph, ultrasonography (US), and computed tomography (CT) scan are being used to diagnose and detect the etiology of pleural effusion. Objective The aim of this work was to compare imaging findings of chest US and CT and the role of chest US in diagnosis of pleural effusion. Patients and methods This observational prospective cohort study was done on 70 patients with pleural effusion of determined etiology admitted to the Chest Department, Menoufia University Hospital, in the period between August 2018 and June 2019. We compared between chest US and CT in different types of pleural effusion. Results This study showed that pleural septations were detected by US more than CT, and the difference was statistically significant (P

Background Invasive fungal infections are on the increase not only among oncology and transplant patients but also among patients admitted to the ICU. Aimof the study The aim is to assess and evaluate the spectrum of respiratory fungal infection in pulmonary ICU. Patients and methods This observational cohort study was carried out on 80 patients admitted in the respiratory ICU of Menoufia University Hospital in the period from January to October 2017. All patients were subjected to fungal culture of sputum or tracheal aspirate, and blood culture in cases of suspected fungemia. All samples were cultured on Sabouraud dextrose agars. Results Of the patients (80), there were 34 (42.5%) patients with positive [13 (16.25%) with positive candida, 15 (18.75%) with positive aspergillus, six (7.5%) with mixed (candida+aspergillus)], and 46 (57.5%) with negative sputum and endotracheal aspirate fungal culture. There was significant statistical difference between sputum fungal culture results regarding the duration of invasive mechanical ventilation and ICU stay duration (P=0.001 for both). Six out of 35 blood fungal culture were positive for aspergillus, while there was no positive blood fungal culture for candida. These six patients were positive in both sputum and blood fungal cultures (aspergillus), three of them were pneumonia patients, one had lung abscess, one had chronic obstructive pulmonary disease and bronchiectasis and one was bronchogenic carcinoma patient. There were significant statistical differences between blood fungal culture results regarding ICU stay duration and body temperature (P=0.028 and 0.005, respectively). Conclusion Fungal infection is an important problem in pulmonary ICU patients, with no typical clinical picture or specific radiographic findings. Candida and aspergillus are the only fungal pathogens that were isolated from the lower respiratory tract samples of pulmonary ICU patients in Menoufia University Hospital.

Background The actual diagnosis of pleural disease (especially for malignancy) depends on the histopathological finding obtained through pleural biopsy or positive pleural fluid cytology result. Pleural tissue biopsies can be obtained by several methods: blind, image-guided, thoracoscopic, or open surgical pleural biopsies. The diagnostic yield of image-guided sampling is increased owing to the ability to precisely target an abnormal area of the pleura. Aim The aim of this work was to compare between ultrasound-guided Abrams needle and medical thoracoscopic pleural biopsies (MT-PB) in exudative pleural effusion and see the diagnostic yield of ultrasound-guided pleural biopsy. Patients and methods This study included 40 patients with exudative pleural effusion admitted to Chest Department, Menoufia University Hospital, during the period from August 2015 to November 2017. All had pleural thickening in contrast-enhanced thoracic computed tomography scan. All patients underwent ultrasound-guided Abrams’ needle followed by MT-PB. Results Compared with MT-PB, the sensitivity and specificity of ultrasound-guided Abrams needle pleural biopsy were 81.58 and 100%, respectively. No difference was identified between the yields of the two methods. Conclusion Ultrasound-guided Abrams needle pleural biopsy considers an alternative to medical thoracoscopy in exudative pleural effusions associated with pleural thickening.

Background: COPD is a multifactorial disease. It is a widely distributed disease with high morbidity and mortality, associated with different pathologies. The link between glutathione S-transferase P-1 (GSTP1) polymorphism and COPD needs to be clarified. Objectives: To show the relationship between GSTP1 gene polymorphism and pathogenesis of COPD, and to clarify the role of smoking in GSTP1 gene polymorphism. Patients and methods: This study carried out on 30 COPD patients met the clinical criteria of COPD set by GOLD 2013 and 20 healthy controls. Blood was sampled for studying GSTP1 gene polymorphism by PCR-RFLP. Results: There was a significant difference between group A (COPD smokers) and group B (COPD non smokers) regarding the presence of non mutant and heterozygous mutation. GSTP1 mutation was significantly higher in group C (smoking controls) than group D (non smoking controls). There was a highly significant difference between smoking subjects than non smoking compared with mutation. There was no significant difference in mutation between smokers and ex-smokers. There was no significant difference between studied subjects having heterozygous mutation and subjects without as regards their spirometry results. Conclusion: There is a significant association between GSTP1 gene polymorphism and the development of COPD, and smoking have a role in GSTP1 gene polymorphism. The polymorphism has no relation to disease severity.

Background: The diagnosis of ventilator associated pneumonia (VAP) remains a challenge because the clinical signs and symptoms lack both sensitivity and specificity and the selection of microbiologic diagnostic procedure is still a matter of debate. Objective: To compare the diagnostic value of bronchoscopic BAL and non-bronchoscopic protected BAL in patients with VAP. Materials and methods: Twenty patients, clinically diagnosed with VAP, were involved in this research; they were evaluated by bronchoscopic and non-bronchoscopic BAL for diagnosis of VAP. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of bronchoscopic and non-bronchoscopic BAL were calculated, taking clinical pulmonary infection score (CPIS) of ⩾6 as reference standard. Results: There was a good microbiologic concordance and strong correlation between bronchoscopic BAL and non bronchoscopic BAL in diagnosis of VAP. There was a high concordance between CPIS score and both procedures’ results. Percentage of concordance between CPIS and bronchoscopic BAL was 97.5% and with non bronchoscopic BAL was 95%. Gram negative organisms were the commonest organisms isolated by both techniques. Conclusion: Non bronchoscopic BAL is an inexpensive, easy, and useful technique for microbiologic diagnosis of VAP. This finding, if verified, might simplify the approach for the diagnosis of VAP.

Background: The accurate diagnosis of pleural effusion remains a challenging problem even after thoracentesis and closed pleural biopsy. Medical thoracoscopy has been established to have a greater diagnostic yield in the diagnosis of exudative pleural effusion. Forceps biopsy, pleural brush and lavage could be used through medical thoracoscopy to obtain pleural specimens. Objective: The aim of this study is to evaluate the role of thoracoscopic pleural lavage and brush in undiagnosed exudative pleural effusion. Patients and methods: This prospective study was carried out on 25 patients having undiagnosed exudative pleural effusion. All patients submitted to medical thoracoscopy, where forceps biopsy, pleural brush and pleural lavage specimens were taken for all patients and sent for histopathological and cytological examination. Results: Combined thoracoscopic pleural specimens were diagnostic in 24 patients (96%), and all of them were malignant. Forceps biopsy was positive in 23 patients (92%), while pleural brush and pleural lavage were positive in 18 patients (72%) and 15 patients (60%) respectively. Pleural brush was the only diagnostic modality in one patient. Minimal complications were recorded. Conclusion: Combined thoracoscopic pleural specimens (forceps biopsy, brush and lavage) increase the diagnostic yield of medical thoracoscopy for patients with undiagnosed exudative pleural effusion than separate them. Thoracoscopic pleural brushing is a safe diagnostic technique as it can brush certain dangerous areas of the pleura. Pleural lavage is more diagnostic than the initial thoracentesis.

Background: Obstructive sleep apnea syndrome (OSAS) is a common disease, affecting about 2–4% of the adult population. Some of the symptoms of OSAS resemble symptoms associated with anxiety and depressive conditions in untreated OSAS, rates of depression are elevated compared with general populations, studies of (CPAP) treatment in OSAS have shown an improvement in symptoms of depression. Aim: To assess depression in patients with obstructive sleep apnea syndrome (OSAS), and the effect of CPAP on it. Patients and methods: This study comprised 30 cases who underwent full history taking, general and local examinations, assessment of daytime sleepiness by Epworth scale, overnight polysomnography using (Embla S 4000, Iceland) and assessment of depression before and 2 month after treatment with CPAP by The Hamilton Depression Rating Scale (HDRS), The Structured Clinical Interview for DSM-IV (SCID) and BECK scale for depression. Results: The mean age of patients was 55 years. Sixteen patients had HDRS scores above the cut-off point of the scale of ten (indicating some sort of depression). After that patients were subjected to SCID. Ten patients (33.3%) fulfilled the clinical diagnosis of a major depressive disorder according to DSM-IV and after CPAP treatment for two months resulted in significant improvements of depressive symptoms in both BDI and HRSD scores. The BDI score decreased from 18.6 ± 9.2 to 9.4 ± 10.1, while the HRSD score decreased from 14.1 ± 8.5 to 7.9 ± 7.2 (both p

Recently, social networks have shown huge potential in terms of collaborative web services and the study of peer influence as a result of the massive amount of data, datasets, and interrelations generated. These interrelations cannot guarantee the success of online social networks without ensuring the existence of trust between nodes. Detecting influential nodes improves collaborative filtering (CF) recommendations in which nodes with the highest influential capability are most likely to be the source of recommendations. Although CF-based recommendation systems are the most widely used approach for implementing recommender systems, this approach ignores the mutual trust between users. In this paper, a trust-based algorithm (TBA) is introduced to detect influential spreaders in social networks efficiently. In particular, the proposed TBA estimates the influence that each node has on the other connected nodes as well as on the whole network. Next, a Friend-of-Friend recommendation (FoF-SocialI) algorithm is addressed to detect the influence of social ties in the recommendation process. Finally, experimental results, performed on three large scale location-based social networks, namely, Brightkite, Gowalla, and Weeplaces, to test the efficiency of the proposed algorithm, are presented. The conducted experiments show a remarkable enhancement in predicting and recommending locations in various social networks.

Background: Hepatitis C virus (HCV) infection is associated with a wide series of extrahepatic manifestations. Pulmonary involvement is one of the extrahepatic manifestations of chronic hepatitis C virus (HCV) infection. The objective of this study was to determine the impact of HCV infection and the degree of liver dysfunction in patients with chronic obstructive pulmonary disease (COPD). Methods: This study was conducted on COPD patients. They were selected from outpatient chest clinic in the Menoufia University Hospital. They were classified into 2 groups the first group COPD patients (n = 40) without hepatitis C and the second group COPD patients with chronic hepatitis C. Second group (COPD with HCV) classified into 3 subgroups according Child–Pugh classification to determine the degree of liver insufficiency. Group IIA: patients Child–Pugh (A), group IIB: patients Child–Pugh (B) and group IIC: patients Child–Pugh (C). The following pulmonary function parameters were recorded: Forced Expiratory Volume in the first second (FEV1), Forced Expiratory Volume percent (FEV1/FVC%), Forced Expiratory Flow 25–75% (FEF 25–75%) and Maximal Voluntary Ventilation (MVV). Results: The study included 80 patients with COPD, 40 patients without chronic HCV infection (group I), and 40 patients with chronic HBV infection (group II).COPD patients with HCV infection have increased deterioration in pulmonary function (FEV1, FEV1/FVC, FEF 25–75% and MVV) than COPD patients without HCV infection. Also there were significant decreases in pulmonary function tests (FEV1, FEV1/FVC, FEF 25–75% and MVV) in group II subgroups IIA, IIB and IIC according to the degree of decompensation. Conclusion: Patients with COPD with HCV infection, have increased deterioration in pulmonary function than patients with COPD without HCV infection and the deterioration increases with hepatitis decompensation.

We report the rare occurrence of donor-derived myeloid sarcoma in two kidney transplant patients who received organs from a single deceased donor. There was no evidence of preexisting hematologic malignancy in the donor at the time of organ recovery. Both recipients developed leukemic involvement that appeared to be limited to the transplanted organ. Fluorescence in situ hybridization (FISH) and molecular genotyping analyses confirmed that the malignant cells were of donor origin in each patient. Allograft nephrectomy and immediate withdrawal of immunosuppression were performed in both cases; systemic chemotherapy was subsequently administered to one patient. Both recipients were in remission at least one year following the diagnosis of donor-derived myeloid sarcoma. These cases suggest that restoration of the immune system after withdrawal of immunosuppressive therapy and allograft nephrectomy may be sufficient to control HLA-mismatched donor-derived myeloid sarcoma without systemic involvement.

Background. Vascular injuries often result in life threatening hemorrhage or limb loss. When they present with a single entry or exit wound, surgery is immediately indicated. With multiple injuries, however, imaging such as CTA is necessary for diagnosis and choice of treatment. Methods. For all combat-related vascular cases admitted to our medical center during the Lebanon wars in 1982 and 2006, we compiled and compared presenting signs and symptoms, means of diagnosis, treatments, and results. Results. 126 patients with vascular injuries were admitted (87 in 1982, 39 in 2006). 90% were male; mean age of 29 years (range 20–53). All injuries were accompanied by insult to soft tissue, bones, and viscera. 75% presented with injury to arteries in the extremities. 75% of these patients presented with limb ischemia, and 25% sustained massive blood loss. Treatments included venous interposition graft, end-to-end anastomosis, venous patch, endovascular technique (only in 2006), and ligation/observation. Complications included thrombosis and wound infections. Mortality and amputations occurred only in 1982, and this may be attributed to the use of imaging, advanced technique, and shorter average time from injury to hospital (7 hours). Conclusions. We recommend CTA as the first line modality for diagnosis of vascular injuries, as its liberal use allowed for early and appropriate treatment. Treatment outcomes improved with fast and effective resuscitation, liberal use of tourniquets and fasciotomies, and meticulous treatment by a multidisciplinary team.

This paper presents NN_ILEACH, a novel neural network-based routing protocol designed to enhance the energy efficiency and longevity of Wireless Sensor Networks (WSNs). By integrating the Energy Hole Removing Mechanism (EHORM) with a sophisticated neural network for cluster head selection, NN_ILEACH effectively addresses the energy depletion challenges associated with traditional protocols like LEACH and ILEACH. Our extensive simulations demonstrate that NN_ILEACH significantly outperforms these classical protocols. Specifically, NN_ILEACH extends the network lifetime to an impressive 11,361 rounds, compared to only 505 rounds achieved by LEACH under identical conditions—representing a more than 20-fold improvement. Additionally, NN_ILEACH achieves a 30% increase in throughput and a 25% enhancement in packet delivery ratio, while reducing overall energy consumption by 40%. These results underscore the protocol's potential to optimize energy usage and maintain network stability, paving the way for more resilient IoT systems in dynamic environments. Future work will explore further integration of machine learning techniques to enhance adaptability and performance in WSNs. [ABSTRACT FROM AUTHOR]