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Abstract Waste and energy sectors have significant contributions to the greenhouse gas (GHG) emissions caused primarily by the population expansion. Waste-to-Energy (WtE) is introduced to address the issue raised by both sectors simultaneously through utilization of the potential energy stored in municipal solid waste (MSW) as well as offsetting GHG emissions. Limited research have been conducted in Egypt to assess the current situation of MSW management and associated methane emissions. The current study focused on estimating the baseline methane emissions for six Egyptian governorates and determining the energy production potential from WtE projects. To achieve this aim, three scenarios have been assessed: Baseline, Landfill Gas to Energy (LFGE), and Incineration scenarios. Key results revealed that a total of 3.7 million tonnes of methane would be emitted from all studied governorates generated over 50 years. Incineration also found to be more favorable in all governorates in terms of energy production, quantity of avoided GHG emissions, and in terms of economic viability over LFGE. Implementing incineration in all governorates would generate about 5.6 TWh energy annually and could avoid about 5 Mt CO2 eq annually in comparison to LFGE that would generate about 0.6 TWh annually and could avoid about 2.5 Mt CO2 eq annually. In terms of economic viability of WtE projects, while they were generally not economically viable under the assumptions made in the current study, incineration technology deemed promising, but policy adjustments, such as competitive Feed-in Tariff (FiT) rates and the inclusion of gate fees, are necessary. Specific minimum gate fees and FiT were identified for each governorate, providing essential guidance for decision makers to ensure the viability of WtE implementation. This study would support the decision makers in assessing technically and financially feasible options for WtE technologies in the selected governorates.

Introduction: Transrectal (TR) prostate biopsy has been the gold standard for prostate cancer diagnosis for years. With the emergence of transperineal (TP) prostatic biopsy, there is a shift in practice across medical services to adopt TP biopsy as the primary method of prostatic biopsy. Objective: The objective of the study is to compare cancer detection rates and complications between TP and TR biopsies in our region providing single-center experience with introduction of TP biopsy. Patients and Methods: This is a retrospective study utilizing a prospectively designed database comparing consecutive 80 cases of TP biopsy to 80 cases of TR biopsy in a single center. Results: Prebiopsy PSA was 14.2 ± 24.9 ng/dl in the TP group versus 23.7 ± 71.3 ng/dl in the TR group with P = 0.108. Prostate Imaging–Reporting and Data System (PIRAD) 4 and 5 lesions were found in 47 (58.9%) cases of TP biopsy versus 44 (60.3%) of TR group cases and P = 0.131. Cancer was detected in 49 (61.25%) patients in the TP group versus 45 (56.25%) in the TR group with no statistically significant difference and P = 0.665. No cases of hematochezia was reported in TP group, vs 14 (17.5%) reported in TR group with P value

Abstract Background Rheumatoid arthritis (RA) is an autoimmune lifelong disease. Systemic manifestations represent a significant aspect of the disease burden. This study aimed to assess sleep quality and psychosocial aspects among RA patients and the impact of disease duration and activity. Results The mean age for included RA patients was 50.00 ± 9.37 years. The median disease duration was 9.50 (Interquartile range (IQR)=5–15) years and 90% of patients were females. Disease activity score 28 was 4.65 ± 1.66. Anxiety and depression were significantly higher among RA participants. Regarding sleep quality assessment, RA group had significantly higher levels of insomnia than the control group (Insomnia Severity Index median (IQR) was 4.5 (0–15) versus 1 (0–3); p value = 0.013) and daytime sleepiness (Epworth Sleepiness Scale median (IQR) was 4 (1–11.25) versus 1 (0–3); p value = 0.002). RA patients showed significantly higher values of Pittsburgh Sleep Quality Index components as well as the global score indicating poor sleep quality. The 36-item short-form health survey domains, representing physical and mental health, were significantly lower among RA cases versus control subjects. Higher disease activity was positively correlated with anxiety, depression, insomnia, sleep quality, sleep efficiency, and daytime dysfunction, while negatively correlated with all domains of the 36-item short-form health survey. Conclusions RA patients have increased anxiety and depression levels in addition to poor sleep quality. High disease activity is linked to increased anxiety and depression levels, impaired quality of life, and poor sleep quality.

Simulator sickness not only degrades the quality of interaction within simulator environments but also poses challenges for user enjoyment and the long-term viability of simulation technologies. The early diagnosis of nausea, disorientation, and oculomotor issues related to simulator sickness is crucial for improving user experience and minimizing adverse side effects. In this paper, we aim to classify and predict the onset of these issues by establishing thresholds that indicate the presence of symptoms. A cohort of 20 participants was subjected to an 8-minute simulated flight video. During this period, both objective and subjective parameters are gathered using the Equivital sensor and questionnaire. Our research demonstrates promising results in predicting nausea symptoms, achieving high accuracy (91.68%), recall (87.50%), F1 score (86.81%), and AUC (0.905). Our findings reveal that while the inter-beat interval serves as a primary predictor of simulator sickness, the combination of other signals with distinct thresholds also plays a critical role in predicting each symptom, highlighting the complex interaction of multiple factors. In conclusion, these findings have significant practical implications for the development of early warning systems and the enhancement of immersive technologies across various domains. Designers and developers can use these insights to improve user experiences, reduce simulator sickness, and optimize the effectiveness of immersive simulations.

Abstract Background Several imaging modalities are available to assess complications post intestinal stoma creation. The aim of this study was the radiological assessment of intestinal complications pre-stomal closure using routine fluoroscopic water-soluble contrast enema (WSCE), combined CT-WSCE, and MRI-enema with rectal gel administration. Additionally, we aimed to investigate the potential alterations in the surgical management plan based on imaging findings. Results This prospective cross-sectional study recruited 130 patients with stomas referred for the assessment of stoma integrity. Thirty-six patients with stoma-related intestinal complications were included. Patients with complications were subdivided into 3 groups. Group A 15 patients with intestinal stomas referred for WSCE pre-stomal closure and complementary CT-WSCE evaluation was performed. Comparison between the detection of the complications by WSCE alone and combined CT-WSCE among group A was statistically significant (p = 0.008) yet the alteration of the surgical plan based on both modalities was not statistically significant (p = 0.063). Group B 11 patients with poor general conditions were referred directly for combined CT-WSCE assessment, complications diagnosed in this group: 6 (54.5%) intestinal obstruction, 2 (18.2%) pericolic collections, 2 (18.2%) abnormal fistula and 1 (9.1%) anastomotic leak. Group C 10 patients with intestinal stomas with malignant or inflammatory conditions referred directly for MRI-enema assessment, showed complications as follows: 3 (30%) colon/rectal tumoral recurrence, 2 (20%) strictures, 2 (20%) pericolic collections and 3 (30%) abnormal intestinal fistulous communications. Comparison between complicated colorectal cancer patients (20 patients) versus other complicated patients secondary to other surgical indications (16 patients) enrolled in the study from the 3 different groups was not statistically significant (p = 0.125). Conclusions Combined CT and WSCE is superior in the detection of intestinal fistulas, peri-colic collections, tumor recurrence, and para-stomal hernias than WSCE alone and might lead to a change of management. MRI after rectal gel administration can serve as reliable substitute in some patients for the detection of intestinal complications namely fistulas and tumor recurrence.

Abstract Background Behçet’s disease (BD) is a multi-organ disease with different systemic manifestations. While rare in the United States and Europe, it is more common in the Middle East and Asia. BD is one of the commonest encountered vasculitis in Egypt. This study aims to evaluate BD patients' sleep patterns, quality of life, and psychological aspects. Methods Patients suffering from Behçet’s disease (thirty patients) and 30 matched age and sex-healthy control participants were recruited in our study. The assessment included the entire clinical history and laboratory investigations, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Oxygen saturation level. Evaluation of sleep quality and presence of sleep-disordered breathing was done using the Pittsburgh Sleep Quality Index (PSQI), Insomnia severity index (ISI), and Epworth sleepiness scale (ESS). Hamilton’s anxiety (HAM-A) and depression rating scales (HAM-D) were used for psychological assessment. The Short Form 36 Quality Of Life Scale (SF-36 QOL) assessed participants' quality of life. Results Behçet’s disease patients suffered significantly higher levels of anxiety and depression compared to the control group. The prevalence of insomnia and daytime sleepiness was significantly higher among BD patients. All components of PSQI, including the global score, were significantly higher among the BD group. Physical functioning, role limitation due to physical health, and emotional problems; also, general health indices were significantly lower for the BD group. Patients with active BD showed significantly higher levels of anxiety, depression, insomnia, day time dysfunction and significantly lower all domains of the SF-36 QOL Scale. Conclusions BD is associated with low sleep quality and high levels of anxiety and depression. Disease activity directly impacts anxiety, depression levels, lower sleep quality, and lower quality of life among BD patients. Trial registration ClinicalTrials.gov. NCT05142995. Registered November 20, 2021.

Introduction: Gaining access to the kidney is crucial step in percutaneous nephrolithotomy (PCNL); it has a steep learning curve. Objective: Describe the mathematical method to predict renal puncture angle and distance based on preoperative computed tomography (CT) measurements. Then evaluating how it correlates with measured values. Patients and Methods: The study was prospectively designed. After ethical committee approval, the study uses data from preoperative CT to construct a triangle so we can estimate puncture depth and angle. A triangle of three points, the first is point of entry to the pelvicalyceal system (PCS), the second is point on the skin perpendicular to it, and the third where the needle punctures the skin. The needle travel is estimated using the Pythagorean theorem and puncture angle using the inverse sine function. We evaluated 40 punctures in 36 PCNL procedures. After PCS puncture using fluoroscopy-guided triangulation, we measured the needle travel distance and angle to the horizontal plane. Then compared the results with mathematically estimated values. Results: We targeted posterior lower calyx in 21 (70%) case. The correlation between measured and estimated needle travel distance with Rho coefficient of 0.76 with P < 0.001. The mean difference between the estimated and the measured needle travel was – 0.37 ± 1.2 cm (−2.6–1.6). Measured and estimated angle correlate with Rho coefficient of 0.77 and P < 0.001. The mean difference between the estimated and the measured angle was 2° ± 8° (−21°–16°). Conclusion: Mathematical estimation of needle depth and angle for gaining access to the kidney correlates well with measured values.

Introduction: Epididymo-orchitis (EO) is a common urological condition. In endemic areas, EO may be the presenting picture of brucellosis. Early suspicion and proper diagnosis is necessary for patient recovery. Objective: The aim of our study is to identify early predictors of Brucella EO. Patients and Methods: We retrospectively collected the data of all patients who were treated at the Urology Unit, Farwaniya Hospital, with acute EO above the age of 12 years between April 2017 and February 2019. Data from electronic and hardcopy files were gathered and analyzed. The diagnosis of acute EO was based on clinical, laboratory, and radiological findings. A total of 120 patients under the diagnosis of EO, epididymitis, and orchitis were reviewed. Thirty-one patients were tested for Brucella based on the history of animal contact, ingestion of unpasteurized dairy products, or persistent fever for more than 48 h. of those patients, 11 tested positive for Brucella orchitis. Results: A comparison between Brucella-positive and Brucella-negative patients regarding age, presence of fever, complete blood count (CBC) parameters, pyuria, and abscess formation was made. In the Brucella group, 72% of the patients had a history of animal contact compared to 33% in non-Brucella group (P = 0.006). When comparing CBC parameters in the two groups, Brucella group had statistically significant lower total leukocytic count and neutrophil count (mean ± standard deviation [SD]) 13.07 ± 4.22, 6.4 ± 9.98 versus Brucella negative group 17.35 ± 5.28, 7.8 ± 10.53, and P values were 0.037 and 0.004, respectively. Brucella group showed lymphocytosis (mean ± SD) 25.95 ± 9.78 versus non-Brucella group 13.22 ± 8.05 and P < 0.01. Conclusion: Brucella orchitis constituted 9% of the orchitis patients treated in our hospital. Patients with a history of animal contact, EO with lymphocytosis, and relative neutropenia should raise the suspicion for Brucella orchitis in endemic areas.

Vehicular motion simulators have evolved to become an important contributor to major industries, including defense, aerospace, and vehicle manufacturing. During the past few decades, many efforts have been made towards developing robust, adaptive motion simulators with the highest level of fidelity and realism. Thus, it is important to recollect, in order to evaluate the current state of complex robotic systems, encouraging careful planning of further improvements in the future. This article focuses on the current motion simulators’ structural designs and working principles alongside the currently developed motion control algorithms to achieve the highest fidelity. Furthermore, within the era of industry 4.0 and the fast-paced merging of technologies into key industries, some suggestions are made for future works which it is believed are worth investigating to provide robustness and adaptivity to the control of simulation systems, improving their fidelity and realism alongside reducing motion sickness experienced by the simulator operator.

Human Centrifuge Systems (HCSs) are an effective training tool to improve the G-acceleration and Spatial Disorientation (SD) tolerance of aircrew. Though highly capable HCSs are available, their structure and performance are yet to be fully optimised to efficiently recreate the G-vectors produced using Aircraft Combat Manoeuvres (ACMs). To achieve this improvement, the relationship between configurational design and HCS performance should be profoundly investigated. This work proposes a framework for identifying the optimal configurational design of an active four Degree-of-Freedom (DoF) HCS. The relationship between configurational design parameters and objective criteria is established using inverse kinematics and dynamics. Then, a multi-objective evolutionary optimiser is used to identify the optimum arm length and seat position, minimising the Coriolis effect, relative acceleration ratio, and cost. The results of the work show that the applied optimisation step can significantly contribute to (1) efficiently replicating the aircraft motion, (2) minimising the detrimental effects generated during HCS motion, and (3) reducing the overall cost of the system. The applied methodology can be adapted to HCSs with different structures and DoFs.

The feeling of self-movement that occurs in the absence of physical motion is often referred to as vection, which is commonly exemplified using the train illusion analogy (TIA). Limited research exists on whether the TIA accurately exemplifies the experience of vection in virtual environments (VEs). Few studies complemented their vection research with participants' qualitative feedback or by recording physiological responses, and most studies used stimuli that contextually differed from the TIA. We investigated whether vection is experienced differently in a VE replicating the TIA compared to a VE depicting optic flow by recording subjective and physiological responses. Additionally, we explored participants' experience through an open question survey. We expected the TIA environment to induce enhanced vection compared to the optic flow environment. Twenty-nine participants were visually and audibly immersed in VEs that either depicted optic flow or replicated the TIA. Results showed optic flow elicited more compelling vection than the TIA environment and no consistent physiological correlates to vection were identified. The post-experiment survey revealed discrepancies between participants' quantitative and qualitative feedback. Although the dynamic content may outweigh the ecological relevance of the stimuli, it was concluded that more qualitative research is needed to understand participants' vection experience in VEs.

Convoying or platooning with a fleet of autonomous vehicles, which is denoted as autonomous convoying in this paper, has attracted increasing attention from the research communities, governments, and private sectors in recent years. Autonomous convoying offers immense opportunities due to its potential in enhancing logistical efficiency as well as reducing road incidents/accidents by eliminating human errors due to stress and fatigue. While humans can make complex decisions, involving humans in decision-making processes often causes delays as compared with those of automated machines. Indeed, human errors cause approximately 90% of road accidents and fatalities. Efficient platooning techniques can also reduce fuel consumption and carbon footprints. This paper presents a concise survey on current research and development initiatives in autonomous convoying while critically discussing the underlying techniques and technologies developed in this domain. Implications of autonomous convoying toward different industries are also analyzed and discussed.

For decades, road crashes have caused many deaths and injuries and generally have had a severe social and economic impact on societies. According to studies, driver distraction has led to an increase in driving-related risks. In recent years, there have been more distracting factors that commonly affect drivers, highlighting the need for a resolution. Therefore, as technology is becoming more advanced, there is an opportunity to minimize these risks, for which driver distraction detection would be required. As there are a variety of distractions that might affect drivers and their performance, there are many studies focusing on this topic. To better understand the field of driver distraction detection, this paper has reviewed the existing studies in this field. For this purpose, different variables of the existing methodologies and experimental setups are identified and explained. Also, the results of these experiments and the impacts of different distraction factors on drivers’ physiological responses, visual signals, or their performances are categorized and described. Furthermore, this study discusses the factors of the existing methodologies and their results, along with pointing out the research gaps. The purpose of this study is to assist future research and investigation in this field, by creating a review that comprehensively covers different aspects of existing studies and discusses and assesses their methodologies and findings.

The TGMD (i.e., Test of Gross Motor Development) has been considered as one of the gold standards of assessment tools for analysis of motor competence in children. However, it is rarely used by teachers in schools because the time, resources, and expertise required for one teacher to assess a class of students is prohibitive in most cases. A potential solution may be to automate the testing protocol using objective measures and inertial measurement unit sensors. An accurate method using 17 sensors to capture full body motion profiles and machine learning methods to objectively assess proficiency has been developed; however, feasibility of this method was low. Subsequently, a simplified method using four sensors (i.e., attached to wrists and ankles) was found to be effective, efficient, and potentially highly feasible for use in school settings. For some skills, however, not all skill criteria could be assessed. Additionally, misclassification on occasion, marred results. In the present paper we consider a previous experiment that used wireless motion capture to assess criteria from the TGMD-3. We discuss the advantages alongside the disadvantages of testing motor competence in children using sensors and consider the question—Can a compromise be struck between accuracy and feasibility?

Abstract Autonomous Vehicles (AVs) have shown indelible and revolutionary effects on accident reduction and more efficient use of travel time, with outstanding socio‐economic impact. Despite these benefits, to make AVs accepted by a wide demographic and produce them on an industrial scale with a reasonable price, there are still a number of technological and social challenges that need to be tackled. Path Tracking Controller (PTC) of AVs is one of the high potential subsystems that can be further improved in order to achieve more accurate, robust and comfortable tracking performance. This study provides a critical review and simulation study of several selected techniques used for the design of PTC of AVs. The AVs are assumed to have limited controllability due to non‐holonomic constraints, such as car‐like vehicles and differential drive mobile robots. A detailed discussion will be provided on the simulation outcomes as well as the pros and cons of each technique for the sake of implementation and improvement of state‐of‐the‐art PTC.

The mismatch in signals perceived by the vestibular and visual systems to the brain, also referred to as motion sickness syndrome, has been diagnosed as a challenging condition with no clear mechanism. Motion sickness causes undesirable symptoms during travel and in virtual environments that affect people negatively. Treatments are directed toward reducing conflicting sensory inputs, accelerating the process of adaptation, and controlling nausea and vomiting. The long-term use of current medications is often hindered by their various side effects. Hence, this review aims to identify non-pharmacological strategies that can be employed to reduce or prevent motion sickness in both real and virtual environments. Research suggests that activation of the parasympathetic nervous system using pleasant music and diaphragmatic breathing can help alleviate symptoms of motion sickness. Certain micronutrients such as hesperidin, menthol, vitamin C, and gingerol were shown to have a positive impact on alleviating motion sickness. However, the effects of macronutrients are more complex and can be influenced by factors such as the food matrix and composition. Herbal dietary formulations such as Tianxian and Tamzin were shown to be as effective as medications. Therefore, nutritional interventions along with behavioral countermeasures could be considered as inexpensive and simple approaches to mitigate motion sickness. Finally, we discussed possible mechanisms underlying these interventions, the most significant limitations, research gaps, and future research directions for motion sickness.

Greenhouses are used to create the appropriate environment for plant growth. Controlling the level of lighting using shading nets is one of the most commonly used methods for making suitable environmental modifications in greenhouses. The objective of this study was to examine the impact of three colored shading nets (green, black, and beige at shading rates of 50%) on inside air temperature, relative humidity, and spectral distribution of light in a greenhouse, as well as their effect on the growth and yield of strawberry plants. Data were collected during winter (December and January) and spring (March and April) months from shaded and unshaded blocks. The green net had the highest transmittance to solar radiation (τSR) during the two periods (38% and 35%, respectively) and the highest transmittance to photosynthetically active radiation (τPAR) of 34% during spring months, while the beige net had the highest τPAR of 27% during winter months. The black net had the smallest τPAR values during the two periods (22% and 29%, respectively). The lowest total light levels per season for solar radiation (SR) and photosynthetically active radiation (PAR) (746.8 and 293.7 MJ·m−2, respectively) were obtained under the black net, compared with (906.7 and 320.8 MJ·m−2, respectively) for the beige net, and (969.6 and 337.2 MJ·m−2, respectively) for the green net. The ratio of PAR to SR (PAR:SR) was 41% and 44% outside and inside the greenhouse for the control (without shade), respectively. The black net had the highest ratio of PAR:SR (39%) among the treatment nets. The green net transmitted more light in the blue–green region (400 to 570 nm) and transmitted the highest photon flux at 480 nm, while the beige net increased the infrared radiation flux from 730 nm and above and transmitted the highest photon flux at 604 nm. The study found that the green net increased the ratio of blue to red light (B/R), while the beige and green nets reduced the red to far-red light (R/FR) ratio. The photosynthetic rate, conductance to water, and transpiration were significantly higher for strawberries grown under the beige net. These results indicate that the beige net positively influenced leaf and stem characteristics, leading to improved strawberry yields. The best yields of strawberries were obtained under the beige net and the control group (no shade), surpassing the yields achieved under the black net by 26.3% and 21.4%, respectively. [ABSTRACT FROM AUTHOR]

Abstract Background Most neuropsychological studies on chemotherapy (CHT)-treated cancer survivors reported cognitive impairments in multiple domains such as executive functions, learning, memory, attention, verbal fluency, and speed of information processing. The CHT effects range from small to moderate, involving mostly the cognitive functions sub-served by frontal lobe. This study aimed to evaluate the role of PET/CT in the assessment of the effect of chemotherapy on the glucose metabolism in the brain in cancer patients after the chemotherapy treatment. Results This was a prospective study carried out in 2 years for patients who have done PET/CT scans for assessment of the change of the glucose uptake in the brain in pre- and in post-therapeutic state. A total number of 30 patients, 8 males and 22 females, were examined. The age of the patients ranged from 29 to 79 years (mean 57.9). Each patient underwent at least two PET/CT scans, first before the initiation of the therapy, and second was at least 3 months after starting the chemotherapy regimen. This study employed an adaptive threshold method, SCENIUM version 2.0.1. Automatic ROI identification was performed through around 10 regions of the brain. After segmentation of FDG uptake in the different brain regions of each subject, we measured average glucose uptake (SUVmean), registered by SCENIUM software. Conclusion There was significant reduction in the brain metabolism “FDG uptake” in all regions of the brain, mainly at the mesial temporal lobes as well as the frontal lobes. This metabolic change proves that chemotherapy has an adverse effect on the brain that can be objectively assessed with modern imaging techniques.

Model Predictive Controller (MPC) is a capable technique for designing Path Tracking Controller (PTC) of Autonomous Vehicles (AVs). The performance of MPC can be significantly enhanced by adopting a high-fidelity and accurate vehicle model. This model should be capable of capturing the full dynamics of the vehicle, including nonlinearities and uncertainties, without imposing a high computational cost for MPC. A data-driven approach realised by learning vehicle dynamics using vehicle operation data can offer a promising solution by providing a suitable trade-off between accurate state predictions and the computational cost for MPC. This work proposes a framework for designing an MPC with a Neural Network (NN)-based learned dynamic model of the vehicle using the plethora of data available from modern vehicle systems. The objective is to integrate an NN-based model with higher accuracy than the conventional vehicle models for the required prediction horizon into MPC for improved tracking performances. The proposed NN-based model is highly capable of approximating latent system states, which are difficult to estimate, and provides more accurate predictions in the presence of parametric uncertainties. The results in various road conditions show that the proposed approach outperforms the MPCs with conventional vehicle models.

Background: In recent years there has been an increasing interest in the practice of regional anesthesia especially peripheral nerve blocks for surgical anesthesia and postoperative analgesia. Imaging guidance for nerve localization helps the promise of improving block success with fewer complications. Among the imaging modalities available nowadays, ultrasonography seems to be the most suitable for regional anesthesia. One the most significant advantage of ultrasound (US) technology is the availability to provide anatomic examination of the area of interest. Aim: The aim of this study is to evaluate the additive effect of dexmedetomidine to levobupivacaine in femoral sciatic block in total knee replacement regarding the onset and duration of both sensory and motor blockade, postoperative analgesia requirements. Patients and methods: After ethical approval, 60 patients aged 45-65 years old, with an American Society of Anesthesiologists (ASA) physical class I and II who underwent total knee replacement using combined femoral-sciatic nerve block, were included in this prospective, randomized, controlled, double-blinded study. Patients were randomly assigned to receive levobupivacaine alone (group B) or dexmedetomidine 100 µg added to levobupivacaine (group BD) [n=30 patients for each group] for combined femoral-sciatic nerve block. Results: This study showed that the addition of dexmedetomidine 100 µg to levobupivacaine during ultrasound-guided combined femoral-sciatic nerve block for total knee replacement was associated with, -20% shorter onset times for sensory and motor block, -25% faster time for surgical readiness, and longer duration of sensory and motor block (+45% and +40%, respectively) and +50% longer duration of analgesia. Conclusion: Addition of dexmedetomidine to levobupivacaine during combined femoral-sciatic nerve block for total knee replacement was associated with faster onset of sensory and motor block, decrease intraoperative and postoperative requirements of analgesia and longer duration of motor block than levobupvicaine alone. [ABSTRACT FROM AUTHOR]

Introduction: Transrectal (TR) prostate biopsy has been the gold standard for prostate cancer diagnosis for years. With the emergence of transperineal (TP) prostatic biopsy, there is a shift in practice across medical services to adopt TP biopsy as the primary method of prostatic biopsy. Objective: The objective of the study is to compare cancer detection rates and complications between TP and TR biopsies in our region providing single-center experience with introduction of TP biopsy. Patients and Methods: This is a retrospective study utilizing a prospectively designed database comparing consecutive 80 cases of TP biopsy to 80 cases of TR biopsy in a single center. Results: Prebiopsy PSA was 14.2 ± 24.9 ng/dl in the TP group versus 23.7 ± 71.3 ng/dl in the TR group with P = 0.108. Prostate Imaging-Reporting and Data System (PIRAD) 4 and 5 lesions were found in 47 (58.9%) cases of TP biopsy versus 44 (60.3%) of TR group cases and P = 0.131. Cancer was detected in 49 (61.25%) patients in the TP group versus 45 (56.25%) in the TR group with no statistically significant difference and P = 0.665. No cases of hematochezia was reported in TP group, vs 14 (17.5%) reported in TR group with P value <.001. There were no statistically significant differences regarding the incidence of febrile urinary tract infection (UTI), hematuria, and hematospermia in the TP group 0 (0%), 7 (8.75%), and 3 (3.75%) versus 2 (2.50%), 14 (17.50%), and 5 (6.25%) in the TR group with P = 0.497, 0.159, and 0.719 consecutively. Conclusion: TP and TR biopsy have comparable cancer detection rates. TP biopsy has a significantly lower rectal bleeding rate than TR biopsy. There is a trend toward lower febrile UTI in the TP group; however, it did not reach statistical significance. [ABSTRACT FROM AUTHOR]

The aim of the study: Is to compare the role of minimum intensity projection (MinIP) images with that of volumetric high resolution computed tomography (HRCT) images in the diagnosis of interstitial lung diseases (ILD). Patients and methods: 180 patients (149 females and 31 males) were included in this prospective study that took place over a duration of two and half years. All patients underwent HRCT and MinIP images. The positive findings were compared recording which technique was better and if MinIP adds a value in reaching an accurate diagnosis. Results: MinIP images showed better visualization of traction bronchiectasis, ground glass opacities and mosaic attenuation pattern, as well as, the cystic lung changes seen in LAM. While MinIP did not add a significant value in thick-walled cystic changes e.g.: honeycombing. Conclusion: MinIP is one of the multiplanar techniques of HRCT that proved throughout our study to be an informative complementary tool increasing the observer confidence and agreement regarding some findings as compared with HRCT alone.

Context: Lower urinary tract symptoms (LUTSs) in elderly males are usually related to benign prostatic hyperplasia (BPH) in the majority of cases. It is estimated that BPH affects half of men above the age of 50 years. Recently, a relationship between Vitamin D deficiency and LUTS in elderly males has been reported. Aims: The aim of this study was to analyze Vitamin D levels in males aged above 50 years presenting with LUTS. Settings and Design: This is a prospective case–control study. Patients and Methods: This was a case–control study in which males above 50 years of age who presented with LUTS (Group A) were compared with a control group (Group B) without LUTS. Both groups were investigated regarding Vitamin D level, prostate-specific antigen (PSA), International Prostatic Symptoms Score (IPSS), prostate size, flow rate, serum calcium levels, and abdominal ultrasonography. Statistical Analysis Used: Statistical software package (SPSS Inc., Chicago, IL, USA) was used for the statistical analyses, performing t-test for quantitative data to compare between the two groups. Pearson's correlation coefficient “r” test was calculated between two quantitative, continuous variables in Group A. P 0.05). The mean value of Vitamin D level was 40.82 ± 29.46 nmol/L in Group A and 70.25 ± 22.42 nmol/L in Group B (P < 0.001). The mean value of prostate size was 50.12 ± 23.24 g in Group A and 30.68 ± 4.90 g in Group B (P < 0.001). The mean serum calcium level was 2.4 ± 0.14 mmol/L and 2.50 ± 0.15 mmol/L in Groups A and B, respectively (P < 0.001). The mean value of PSA in Group A was 2.24 ± 1.95 ng/ml versus 2.11 ± 0.45 ng/ml in Group B (P < 0.001). The mean value of IPSS in Group A was 13.38 ± 5.32 ml/s versus 3.41 ± 2.42 ml/s in Group B. The mean value of Q max in uroflowmetry in Group A was 11.5 ± 2 ml/s versus 15.4 ± 1 ml/s in Group B. Conclusions: Men older than 50 years of age with LUTS have lower levels of Vitamin D compared to men without LUTS.

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