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Background: Depression is a worldwide common mental disorder. According to the WHO reports, the total number of people with depression was more than 300 million in 2015, which was corresponding to 4·4% of the world’s population. The aim of the study is to explore the associations of dietary pattern and depressive symptoms. This cross-sectional study used data of staff members and their assistants in Minia University. Dietary pattern was obtained from three days food records and average was taken. Depressive symptoms were assessed by center of epidemiological studies for depression (CES-D) scale. Logistic regression models were used to estimate the associations of dietary pattern with the risk of depressive symptoms. A total of 210 individuals aged 25 years and older were included in this study. Low fiber intake was the most important factor associated with presence of depressive symptoms (CES-D ≥16); OR= 12.130, C.I.95%= 2.718- 54.139, P= 0.001. The present study demonstrated that dietary fibers might reduce the risk of depressive symptoms in adults.

Background The Coronavirus 2019 is a pandemic that has spread worldwide, threatening human health. The main cause of death in patients with COVID-19 is a systemic pro-inflammatory mechanism that quickly progresses to acute respiratory distress syndrome. Hematological ratios as affordable indicators of inflammatory response were studied in COVID-19 patients. The study aimed to study the importance of the blood cell indexes of the systemic inflammatory response, as the Aggregate Index of Systemic Inflammation (AISI), neutrophils lymphocyte to platelet ratio (NLPR), systemic immune-inflammation index (SII) and, systemic inflammation response index (SIRI) in predicting intensive care unit (ICU) admission of COVID-19 patients. Methods 495 COVID-19 patients managed in four tertiary centers; divided into non-ICU and ICU groups. Results Total leucocyte count (TLC), AISI, NLPR, SII, and SIRI were more elevated in the ICU group (P P = 0.006), while this group had less absolute lymphocyte count (ALC) (P = 0.047). We estimated the optimal cut-off values of the hematological ratio; AISI (729), NLPR (0.0195), SII (1346), and SIRI (2.5). SII had the highest specificity (95.6%), while NLPR had the highest sensitivity (61.3%). Age, AISI, CRP, D-dimer, and oxygen aid were the independent predictors for ICU admission in COVID-19 in multivariate logistic regression. Conclusion AISI is a predictor for severity and ICU admission in COVID-19 patients, SII is a predictor of survival, while NLPR and SIRI have an additive role that needs further evaluation.

This study has clarified the simulation of the nonlinear cross phase modulation (CPM) performance signature in optical fiber telecommunication systems. We have been clarified the max Q factor in relation to Cross phase shift modulation for the previous models and proposed model. The optimum optical power varied with spectral time and wavelength variation that is simulated for 90° cross phase shift modulation. Optimum total optical and electrical signal power is demonstrated for 90° Cross phase shift modulation. The max signal quality factor and min BER are assured for various degrees based on cross phase shift modulation. In addition to the optimum signal quality factor is emphasized for 90° Cross phase shift modulation.

Objectives To compare the outcome for DBT-detected and DM-detected suspicious AD, to evaluate the risk of malignancy and if is affected by the US or MRI imaging correlation. Methods All cases with suspicious AD (ultimately assigned BI-RADS 4 or 5 categories) were retrospectively included. Two radiologists independently reviewed DM and DBT images in two sessions for detection (DM vs. DBT). US and MRI imaging correlation findings were recorded. Pathologic results were compared between DBT-detected and DM-detected AD. Results Among 137 detected ADs, 103 (75.2%) were DM-detected, and 34 (24.8%) were only DBT-detected (p = 0.01). The malignancy rate was lower for DBT-detected than DM-detected AD (14.7% vs. 45.6%) (p = 0.01). Malignancy rate was higher with US-positive than US-negative correlation at DM-detected AD (49.4% vs. 27.8%) (p = 0.01). Malignancy rate was not different for DBT-detected AD with (16.7%) or without (12.5%) sonographic correlation. NPV based on radiologists' level of suspicion was high (86.2%-97.2%) but not sufficient enough to forgo biopsy. Of 34 sonographically occult ADs, a positive-MRI correlation was identified in 19 (55.9%) ADs (7 were malignant, 12 were benign). A negative-MRI correlation was identified in 15 (44.1%) ADs; all had a benign outcome (p = 0.01). Conclusions DBT-detected AD is less likely to represent malignancy than does DM-detected; however, the risk of malignancy is not low enough to forgo biopsy. MRI-negative correlation in sonographically occult AD was significantly associated with benign outcomes and can avoid unnecessary interventions.

Shimaa A Ahmed,1 Ghada EM Abdallah,2 Mai M Aly,2 Eman M Nagiub Abdelsalam,3 Mostafa F Mohammed Saleh2 1Department of Internal Medicine, Faculty of Medicine, South Valley University, Qena, Egypt; 2Clinical Hematology Unit, Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt; 3Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, EgyptCorrespondence: Mostafa F Mohammed Saleh Tel +201013701057Fax +2088-2332278-2080278Email mostafafaisal2017@yahoo.comIntroduction: A positive direct antiglobulin test (DAT) with or without autoimmune hemolytic anemia is a frequent finding in chronic lymphocytic leukemia (CLL). The heterogenic clinical course of CLL mainly depends on different pathogenetic mechanisms which appears in a form of variable biological and clinical features. These features allow stratification of patients into subsets with different outcomes.Patients and Methods: We evaluated the DAT as a prognostic marker in 120 CLL patients treated with chemoimmunotherapy. Clinical and laboratory features, treatment response, and survival outcomes of CLL patients were assessed in relation to their DAT test status. Additionally, the English literature was extensively reviewed regarding the prognostic impact of a positive DAT in CLL.Results: DAT positivity was detected in 36 patients (30%) and was associated advanced disease staging (P = 0.03). No correlations were found with other clinical, laboratory, or biological factors such as ZAP-70 or CD38. Both a positive DAT and an Eastern Cooperative Oncology Group performance status > 2 were predictors for non-response to first-line treatment in the multivariate analysis (OR = 0.3, 95% CI: 0.12– 0.8 and OR = 0.2, 95% CI: 0.08– 0.8, respectively). The five-year progression-free survival was significantly lower in the DAT-positive group (P = 0.004). No significant association was found with overall survival (P = 0.2). Sixteen reports analyzing more than 11,000 patients were identified in our review.Conclusion: In conclusion, DAT positivity in CLL patients is associated with poor response to treatment and disease progression.Keywords: autoimmunity, chronic lymphocytic leukemia, direct antiglobulin test, autoimmune hemolytic anemia

The Society for Cardiovascular Magnetic Resonance (SCMR) is an international society focused on the research, education, and clinical application of cardiovascular magnetic resonance (CMR). The SCMR web site (https://www.scmr.org) hosts a case series designed to present case reports demonstrating the unique attributes of CMR in the diagnosis or management of cardiovascular disease. Each clinical presentation is followed by a brief discussion of the disease and unique role of CMR in disease diagnosis or management guidance. By nature, some of these are somewhat esoteric, but all are instructive. In this publication, we provide a digital archive of the 2019 Case of the Week series as a means of further enhancing the education of those interested in CMR and as a means of more readily identifying these cases using a PubMed or similar search engine.

To evaluate the diagnostic performance of DCE MRI and DWI in the assessment of pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in patients with muscle-invasive bladder cancer (MIBC). This prospective study included 90 patients with MIBC who finished NAC. Two radiologists independently assessed MRI for the determination of semi-quantitative parameters (wash-in rate and wash-out rate) and apparent diffusion coefficient (ADC) value. The correlation between pCR and wash-in rate, wash-out rate, ADC value were analyzed. The area under the ROC curve (AUC) was used to evaluate the diagnostic performance for detecting pCR. Inter-reader agreement was assessed using the ICC statistics. On cystectomy specimens, pCR was confirmed in (43.3%, 39/90). pCR is negatively correlated with wash-out rate (r = − 0.701, p = 0.01) and ADC value (r = − 0.621, p = 0.01). ADC value is positively correlated with wash-out rate (r = 0.631, p = 0.001). The diagnostic accuracy of ADC value (cut-off value: 0.911 × 10−3mm2/s) and wash-out rate (cut-off value: 0.677 min−1) in the identification of pCR was (92% for reader 1, 91% for reader 2), and (90% for reader 1, 88% for reader 2), respectively. The sensitivity, specificity for predicting pCR using ADC value + washout rate cut off values were 95.4%, 97.7% for reader 1, and 96%, 97% for reader 2, respectively. AUC was 0.981 for reader 1, 0.971 for reader 2. The overall reproducibility of the mean ADC value and wash out rate was excellent (ICC = 0.83–0.90). The ICC values for the mean ADC value, washout rate was 0.89 (95% CI 0.84–0.89) and 0.87 (95% CI 0.86–0.91), respectively. Semi-quantitative parameter (wash-out) derived from DCE-MRI and ADC has the potential to assess the tumor’s complete pathologic response. The two parameters using together can offer the best possibility to identify complete response to NAC in MIBC.

The cotton aphid, Aphis gossypii (Glover.) had four peaks during the first season and three peaks during the second season, the cotton thrips, Thrips tabaci Lindeman had two peaks during both seasons, the sweet potato white fly, Bemisia tabaci (Genn.) had two peaks during the first season and four peaks in the second season and Empoasca spp. exhibited three peaks during the first season and two peaks in the second season. Also, the lady bird beetle, Coccinella undecimpunctata L. had seven peaks during both seasons. Whereas the green lacewing, Chrysoperla carnea ( Steph.) had seven peaks during 2018 season and eight peaks during 2019 season. The parasitoid, A. colemani had three peaks during 2018 season and five peaks during 2019 season on the cotton aphid.There was a correlation between insect pests and the natural enemies, insignificant positive correlation was observed between C. undecimpunctata and both of A. gossypii and T. tabaci in both seasons. However, C. undecimpunctata has highly significant positive correlation with B. tabaci in the first season only, but it has a significant positive correlation with Empoasca spp. in the first season only . C. carnea, has a highly positive significant correlation with the aphid and the whitefly numbers in the season 2018, whereas during the second season 2019 the correlation was highly positive significant with the whitefly and the green leafhoppers only. The correlation between the parasitoids A. colemani and the aphid was highly significant during both seasons.

This work aimed at evaluating the inhibitory effect of ten natural bioactive compounds (1–10) as potential inhibitors of SARS-CoV-2-3CL main protease (PDB ID: 6LU7) and SARS-CoV main proteases (PDB IDs: 2GTB and 3TNT) by molecular docking analysis. The inhibitory effect of all studied compounds was studied with compared to some proposed antiviral drugs which currently used in COVID-19 treatment such as chloroquine, hydroxychloroquine, azithromycin, remdesivir, baloxvir, lopinavir, and favipiravir. Homology modeling and sequence alignment was computed to evaluate the similarity between the SARS-CoV-2-3CL main protease and other SARS-CoV receptors. ADMET properties of all studied compounds were computed and reported. Also, molecular dynamic (MD) simulation was performed on the compound which has the highest binding affinity inside 6LU7 obtained from molecular docking analysis to study it is stability inside receptor in explicit water solvent. Based on molecular docking analysis, we found that caulerpin has the highest binding affinity inside all studied receptors compared to other bioactive compounds and studied drugs. Our homology modeling and sequence alignment showed that SARS-CoV main protease (PDB ID: 3TNT) shares high similarity with 3CLpro (96.00%). Also, ADMET properties confirmed that caulerpin obeys Lipinski’s rule and passes ADMET property, which make it a promising compound to act as a new safe natural drug against SARS-CoV-2-3CL main protease. Finally, MD simulation confirmed that the complex formed between caulerpin and 3CLpro is stable in water explicit and had no major effect on the flexibility of the protein throughout the simulations and provided a suitable basis for our study. Also, binding free energy between caulerpin and 6LU7 confirmed the efficacy of the caulerpin molecule against SARS-CoV-2 main protease. So, this study suggested that caulerpin could be used as a potential candidate in COVID-19 treatment.

Presently, the SARS-CoV-2 (COVID-19) pandemic has been spreading throughout the world. Some drugs such as lopinavir, simeprevir, hydroxychloroquine, chloroquine, and amprenavir have been recommended for COVID-19 treatment by some researchers, but these drugs were not effective enough against this virus. This study based on in silico approaches was aimed to increase the anti-COVID-19 activities of these drugs by using caulerpin and its derivatives as an adjunct drug against SARS-CoV-2 receptor proteins: the SARS-CoV-2 main protease and the SARS-CoV-2 spike protein. Caulerpin exhibited antiviral activities against chikungunya virus and herpes simplex virus type 1. Caulerpin and some of its derivatives showed inhibitory activity against Alzheimer’s disease. The web server ANCHOR revealed higher protein stability for the two receptors with disordered score (

To assess the utility of MDCT tumor–vascular interface criteria for predicting vascular invasion and resectability in borderline pancreatic cancer (BRPC) patients after neoadjuvant therapy (NAT). This prospective study included 90 patients with BRPC who finished NAT, showed no progression in preoperative CTs and underwent surgery. Two radiologists independently assessed preoperative vessel-tumor interface criteria. The area under the ROC curve (AUC) was used to evaluate the diagnostic performance for predicting vascular invasions and resectability using surgical and pathological results as the gold standard. Inter-reader agreement was assessed using the κ coefficient. Pathologic vascular invasion was confirmed in 47 (54.7%) veins and 14 (16.3%) arteries. R0 resection was achieved in (82.6%71/86) pancreatic resection. Using criteria of circumferential interface ≥ 180 degrees with contour deformity ≥ grade 3 and/or length of tumor contact > 2 cm to predict vascular invasion, the AUCs for the two readers were 0.85–0.88 for arterial invasion and 0.92–0.87 for venous invasion. Using criteria of circumferential interface ≤ 180° with contour deformity ≤ grade 2 and/or length of tumor contact

Lipolytic enzymes catalyze the hydrolysis and synthesis of ester compounds. They are valuable in the pulp, food, and textile industries. This study aims to comprehensively evaluate the extreme properties of a hormone-sensitive lipase (EstATII-TM) isolated from the Red Sea Atlantis II brine pool. EstATII-TM was cloned, expressed, and its biochemical activities were assessed under different conditions. EstATII-TM catalytic properties and resistance to different metal ions were compared to commercial thermophilic esterases under different temperatures. Phylogenetically, EstATII-TM was assigned to the GDSAG motif subfamily of hormone-sensitive lipase. The optimal enzyme activity was evident at a temperature of 30 °C and pH 7–8. The enzyme retained 84.9% of its activity at 0.5 M NaCl. EstATII-TM maintained 93% to 97% activity at −40 and −20 °C, respectively. EstATII-TM activity was significantly enhanced, up to 10-fold, at temperatures ranging from 45 to 65 °C in the presence of 1 mM Cu2+, Cd2+, Ba2+, Mn2+, and Zn2+. EstATII-TM showed superior catalytic activity and resistance-to/enhancement-by metal ions compared to two commercial thermophilic esterases. The Red Sea Atlantis II brine EstATII-TM is characterized by tolerance to high temperatures, stability to hot and cold conditions, as well as toxic heavy metal contamination, making it an ideal candidate for industrial processes.

The sickle cell trait (SCT) disorder possesses a clinical heterogeneity ranging from a symptomless condition to sudden death. This study aimed to develop a diagnostic approach that helps the characterization and identification of SCT from normal subjects and sickle cell disease (SCD) patients, and to assess its severity.Sixty controls, 24 SCD patients and 31 SCT subjects were assessed clinically, radiologically and by laboratory investigations.Of the SCT subjects, 12.8% were symptomatic (3.2% anemic, 6.4% hemolytic crisis, and 3.2% painful crises). Anemia was normocytic in 66.6%, and normochromic and polychromatic in 33.4%. Significantly lower red blood cells (RBCs), hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), hematocrit (Hct), Shine and Lal index (SL), and hemoglobin A (Hb A), and higher mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), Ricerca index (RI), and Huber-Herklotz index (HH) were found in SCT subjects compared with the controls. Hb A and hemoglobin S (Hb S) were excellent in discriminating SCT from SCD (cut-off for SCT50% and40%) followed by Hct, MCHC, Hb, Green and King index (GK), and England and Fraser index (EF) (cut-off for SCT33%,32,11,71, and10, respectively). Radiologically normal findings were detected in 87% of SCT subjects; they had nearly normal liver and renal function tests (except one case each). A schematic diagnostic paradigm for SCT was proposed.This study allowed understanding of SCT in various aspects, i.e., clinical, hematological, biochemical and radiological. Thus, it could help prevention of the Hb S variant disorder and proper management of carriers. This might be applied in pre-marital screening, particularly in those with family history of Hb S disorder.

Pulmonary embolism (PE) a consequence of hypercoagulability status associated with chronic obstructive pulmonary disease (COPD) and worsens its course. Recently, microRNAs (miRNAs) have been linked to PE in COPD settings. We aimed to measure expression levels of miRNAs145 and 126 in COPD patients with and without PE.Herein, miRNA (145 and 126) expression levels were measured in 250 COPD patients with PE by quan-titative real-time PCR, and their data were compared with 300 COPD patients without PE.Our results showed that miRNA-145 expression was downregulated in COPD patients with PE compared to those without PE. The reverse was observed in miRNA-126 expression that was higher in COPD patients with PE than in those without PE. miRNA-145 correlated positively with FEV1/FVC and correlated negatively with D-dimer in all patients regardless of the presence of PE. In addition, miRNA-126 positively correlated with D-dimer and negatively correlated with FEV1/FVC in all studied COPD patients.Lower levels of miRNA-145 and higher levels of miRNA-126 associated with worse diagnosis PE in patients with COPD. Extensive studies are mandated to bring a better understanding of the role of these miRNAs in the mechanism of thrombosis in COPD patients.

Graphical abstract, Highlights • Concurrent capecitabine with radiotherapy in painful bone metastases was safe. • It was effective in palliation of pain from bone metastases in breast cancer patients. • It associated with higher overall response rates regarding pain control. • This decreased analgesic consumption and improved the quality of life., Background In breast cancer, painful bone metastases are common. Local radiotherapy is the standard treatment of painful bone metastases. Pain control and overall response rateswere low in radiotherapy alone. The objectives of this study were to compare the safety and efficacy of external beam radiotherapy with concurrent capecitabine vs. external beam radiotherapy alone in pain control of painful bone metastases in breast cancer patients. Materials and methods Eighty-four patients with painful bone metastases from breast cancer participated in this prospective study. We randomized the patients into two groups: group A treated with radiotherapy 30 Gy in 10 fractions and group B treated with capecitabine 825 mg/m2 every 12 hrs. concurrently with the same radiotherapy dose. Results There was no statistically significant difference between the two groups regarding early treatment toxicity. Most of the toxicity was gastrointestinal (diarrhea and nausea) and mild (grade I or II). The median pain score decreased from week one, and there was a marked response at week4. The difference in median pain score between both groups was statistically significant with p-value = 0.045. The median analgesic score in both groups was statistically significant with a p-value = 0.032 at week 12. A complete response to pain at week 4 was 19% and 42.9% in groups A and B, respectively. Conclusion Concurrent chemoradiation in painful bone metastases from breast cancer origin was tolerable and safe; it had a higher overall response rate and pain palliation than radiotherapy alone.

Coronaviruses belong to a large family of viruses that lead to respiratory infection of various severity. Hematological ratios are indicators of the inflammatory response that are widely used in viral pneumonia with affordability in developing countries. Aim: Study the role of the Neutrophil Lymphocyte ratio(NLR), derived NLR ratio(d-NLR), Platelet Lymphocyte ratio(PL/LR), and Lymphocyte Monocyte ratio(LMR) in predicting the outcome of COVID-19 Egyptian patients. Methods: A retrospective study on 496 COVID-19 Egyptian patients, managed in four tertiary centers; grouped into non-severe, severe, and critical. Results: Critical group of patients had the highest Total leucocyte count(TLC), absolute neutrophil count(ANC), absolute monocyte count(AMC), NLR, d-NLR and, PL/LR (p We calculated the optimal cut-off values of the hematological ratio; NLR(3.5), d-NLR(2.86), PL/LR(192), and LMR(3). D-NLR had the highest specificity(89.2%) while NLR had the highest sensitivity(71.4%). By univariate logistic regression; age, DM, HTN, cardiovascular diseases, COPD, NLR, d-NLR, LMR and PL/LR, CRP, steroid, oxygen aids, and mechanical ventilation were associated with severity of COVID-19 but only age, NLR, CRP, and oxygen aid were independent predictors in multivariate logistic regression. Conclusion: NLR is a predictor for severity in COVID-19. LMR, d-NLR, and PL/LR may assist in risk stratification.

Background The health-promoting effects along with global economic importance of consuming food products supplemented with probiotic microorganisms encouraged the researchers to discover new probiotics. Results Fourteen lactic acid bacterial isolates were identified as Enterococcus mediterraneensis, Lactobacillus fermentum, and Streptococcus lutetiensis by 16S rRNA gene sequencing, and in vitro characterized for their actual probiotic potential. All E. mediterraneensis isolates were resistant to clindamycin, whereas Lb. fermentum isolates were resistant to ampicillin, clindamycin, and vancomycin. The E. mediterraneensis and Lb. fermentum isolates displayed high overall digestive survival, ranged from 1.35 ± 0.06 to 32.73 ± 0.84% and from 2.01 ± 0.01 to 23.9 ± 1.85%, respectively. All isolates displayed cell surface hydrophobicity, ranged between 15.44 ± 6.72 and 39.79 ± 2.87%. The strongest auto-aggregation capability, higher than 40%, was observed for most E. mediterraneensis and Lb. fermentum isolates. The E. mediterraneensis isolates (L2, L12, and L15), Lb. fermentum (L8, L9, and L10), and Strep. lutetiensis (L14) exhibited the greatest co-aggregation with Salmonella typhimurium, Escherichia coli O157:H7, Staphylococcus aureus, and Bacillus cereus. Fifty-seven and fourteen hundredth percent of E. mediterraneensis isolates could be considered bacteriocinogenic against E. coli O157:H7, B. cereus, and S. aureus. Conclusion This study is the first one to isolate Enterococcus mediterraneensis in Egypt and to characterize it as new species of probiotics globally. According to the results, E. mediterraneensis (L2, L12, and L15), Lb. fermentum (L8, L9, and L10), and Strep. lutetiensis (L14) are the most promising in vitro probiotic candidates.

One of the most important challenges in the design of the piezoelectric energy harvester is its narrow bandwidth. Most of the input vibration sources are exposed to frequency variation during their operation. The piezoelectric energy harvester’s narrow bandwidth makes it difficult for the harvester to track the variations of the input vibration source frequency. Thus, the harvester’s output power and overall performance is expected to decline from the designed value. This current study aims to solve the problem of the piezoelectric energy harvester’s narrow bandwidth. The main objective is to achieve bandwidth broadening which is carried out by segmenting the piezoelectric material of the energy harvester into n segments, where n could be more than one. Three arrays with two, four, and six beams are shaped with two piezoelectric segments. The effect of changing the length of the piezoelectric material segment on the resonant frequency, output power, and bandwidth, as well as the frequency response is investigated. The proposed piezoelectric energy harvesters were implemented utilizing a finite element method (FEM) simulation in a MATLAB environment. The results show that increasing the number of array beams increases the output power and bandwidth. For the three-beam arrays, at n equals 2, 6 mW output power and a 9 Hz bandwidth were obtained. Moreover, the bandwidth of such arrays covered around 5% deviation from its resonant frequency. All structures were designed to operate as a steel wheel safety sensor which could be used in train tracks.

Rationale and Objectives The purpose of this study was to compare the accuracy of MDCT and laparoscopy in the prediction of peritoneal carcinomatosis index score. Reproducibility of MDCT interpretation was also assessed. Methods This prospective study included 85 ovarian cancer patients underwent MDCT and diagnostic laparoscopy before cytoreductive surgery. We calculated the accuracy of diagnostic modalities in the calculation of the peritoneal cancer index score (PCI). Radiologist interobserver agreement was calculated using kappa statistics. Results Nine hundred-thirty (84.2%) of the 1105 regions had peritoneal deposits at exploratory laparotomy. Computed tomography (CT) and laparoscopy sensitivity were 94.9%, 98.3%, specificity 86.7%, 80.4%, PPV 97.9 %, 96.8%, NPV 72.2%, 88.8 %, and accuracy 93.8 %, 95.7%, respectively. However, computed tomography (CT) diagnostic performance is less accurate than laparoscopy in pelvic and small intestinal regions; no statistically significant differences were evident regarding total PCI score compared to surgery (p> 0.05). CT and laparoscopy correctly depicted peritoneal carcinomatosis in 88.2%, 90.6% of patients, respectively. Optimal cytoreduction was achieved in 68 (80%) patients. Conclusion Both CT and laparoscopy seems to be effective tools for assessment of peritoneal carcinomatosis using the PCI score. Dedicated MDCT protocol with routine use of a standardized PCI form may provide better comprehensive multi-regional analysis that may help surgeons referring patients to the best treatment option. Laparoscopy is a valuable tool in cases with a high risk of suboptimal cytoreduction related to disease extent.

Background Our purpose was to evaluate the diagnostic accuracy of hysterosalpingography (HSG) in the diagnosis of the uterine cavity and tuboperitoneal abnormalities in infertile women. Reproducibility and consistency were also assessed. Two hundred infertile females underwent HSG, hysteroscopy, and/or laparoscopy as part of infertility workup. HSG examinations were retrospectively reviewed by three radiologists; we compared interobserver variability, and differences between the two results of reading the same examination after 3 months were compared to calculate intraobserver variability. HSG sensitivity, specificity, PPV, NPV, and accuracy were calculated. Results The overall accuracy of HSG in diagnosing tubal, uterine cavity, and peritoneal abnormalities was 95.5%, 95%, and 89%, respectively (P value HSG is reproducible in diagnosing normal versus abnormal examinations. Reproducibility in diagnosing uterine cavity, tubal, and peritoneal abnormalities was (ICC = 0.90), (ICC = 0.70), and (ICC = 0.31), respectively. Best agreement was seen in diagnosing luminal filling defect (sub mucous fibroid/polyp) (ICC = 0.90) (95% CI 0.86–0.98), whereas poorest agreement was found in diagnosing uterine adhesions (ICC = 0.13) (95% CI 0.10–0.13) and pelvic adhesions (ICC = 0.12) (95% CI 0.10–0.13) (P value HSG consistency ranged from moderate to good (K = 0.49–0.79). It was highest in diagnosing normal versus abnormal examination (P value Conclusion HSG has high validity in negative results; it can minimize the use of invasive procedures. Laparoscopy is recommended in patients who had a pelvic disease or showing tubal obstruction on HSG.

Background To assess the validity and accuracy of GI-RADS classification in the prediction of malignancy and in triaging the management protocol in ovarian lesions. Results One hundred fifty-six ovarian lesions were detected in the examined 116 women. The prevalence of malignant tumors was 44%. Overall GI-RADS classification rates were as follows: 41 cases (26.3%) were classified as GI-RADS 1, 26 cases (16 .7%) as GI-RADS 2, 34 cases (21.8%) as GI-RADS 3, 14 cases (8.9%) as GI-RADS 4, and 41 cases (26.3%) as GI-RADS 5. No follow-up was done in GI-RADS 1 patients. A final diagnosis of all GI-RADS 2 ovarian masses such as functional cyst (n = 10), hemorrhagic cysts (n = 8), corpus luteal cysts (n = 6), and some GI-RADS 3 as simple cysts (n = 10) was made by spontaneous resolution of these masses at follow-up after 6 weeks. Fifteen cases of GI-RADS 3 as mature teratoma, serous and mucinous cystadenoma, endometrioma, and ovarian torsion and all GI-RADS 4 and 5 underwent laparoscopic or surgical removal of the ovarian mass with histopathological examination. The diagnostic performance of the GI-RADS in predicting the risk of malignancy in ovarian masses was as follows: 98.11% sensitivity, 95.15% specificity, 91.2% positive predictive value (PPV), 99.2% negative predictive value (NPV), and 20.2 positive likelihood ratio, and the overall accuracy was 96.2% (area under receiver operating curve (AUC) = 0.96, P < 0.001). Conclusion GI-RADS classification performs well as a reporting system of the ovarian masses with high diagnostic performance in the prediction of malignancy, and it seems to be a helpful tool in triaging management in patients with ovarian masses. Trial registration The trial was registered in the US National Library of Medicine, under clinical trial number NCT03175991. Also, the ethical committee approval number of the Faculty of Medicine, Assiut University, was 17100016 on February 28, 2017.

Topical application of a single dose (10µl/tick or egg batch) of different concentrations of abamectin (an avermectin) has lethal and biological effects on the engorged mated adult female, immatures and egg of Argas (Persicargas) arboreus that induced 100% mortality at 25,15 and 10 ppm, respectively. Abamectin treatment at lower concentrations of 1-10 ppm interfered with the female reproduction, nymphal and egg development. Abamectin topical (3-10 ppm) application on mated engorged adult female A. (P.) arboreus at different intervals of its reproductive cycle reduced fecundity and fertility of the female, prolonged its preoviposition, oviposition and the egg incubation periods. The effects were most prominent during vitellogenesis and the least at the start of oviposition. Abamectin treatment of the newly moulted fed 2nd nymphal instar, delayed its moulting and of the resulted 3rd instar and reduced adult emergence. The treatment caused paralysis and various deformities (15.6-28.6%) as missing legs at the coxal level, changes in colour and failure to moult or to detach the old exuvia in the resulted 3rd nymphal instar. Egg batch treatment by dipping the freshly deposited eggs for 20 seconds in an aqueous solution of 1-5 ppm abamectin was more effective in reducing normal hatching, increasing unhatching and total inhibition of egg development than topical treatment. However, both methods of treatment similarly prolonged the egg incubation periods and caused abnormal hatching, malformations, and anomalies in the eggs and embryos

Lufenuron (chitin synthesis inhibitors) and Oryza sativa bran extract (waste product) exhibited insecticidal activity on females of Schistocerca gregaria when they were treated as one day old of the 5th nymphal instar with different concentrations of tested compounds. Some biological aspects, failure of ecdysis to adults, adult mortality, prolongation in the age of last nymphs and developmental events were investigated after treatment. Quantitative and qualitative determination of protein and DNA contents were investigated in normal and affected eggs which resulted from females Schistocerca gregaria treated as one day old 5th nymphal instarwith LC50 ofLufenuron and Oryza sativa bran extract during embryogenesis. The total protein content of normal eggs at 0-day old, was 81.07 mg protein/gm eggs, after one day of oviposition the total protein increase significantly (p

Background: Sleep in the postpartum period is a concern due to robust associations with wake disturbance, fatigue, and depression. Objectives: The aim of this study was to assess sleep disturbances and fatigue among women in postnatal period. Subject and Methods: Design a descriptive study design was utilized in this study. Settings the study was carried out in six health centers in Port-Said city namely (El-Manakh, Bank El-Escan, El-Arab, El-Kuwait, Port-Fouad (2), and Omar Ebn-ElKhatab). Sample a Purposive sample was followed in the present study. The study subjects consisted of 322 postpartum women recruited from postpartum outpatient clinics in the above mentioned settings. A Structured interviewed schedule sheet, the Global Sleep Assessment Questionnaire (GSAQ), and the Multidimensional Fatigue Symptom Inventory Short (MFSI_SF). Results: The study’s results indicated that (69.6%) had high sleep disturbance, and (93.8%) had high fatigue. There was statistical significant relation between sleep disturbance and women's residence (p=0.007), women's mode of delivery (p=0.015), and women with problems after delivery (p=0.019). There were statistically significant relationship between fatigue and crowding index (p=0.009), women's residence (p=0.021), complication after delivery (p=0.009), hospital's stay after delivery (p= 0.018), and receiving help for caring the baby from their sisters (p=0.042). Conclusion: It was concluded that, the great majority of the studied women had postnatal fatigue, and about more than two-thirds of them had sleep disturbance. Factors that were increased these problems including living with extended family and high crowding index. Receiving postnatal instructions seems to decrease both sleep and fatigue problems; both sleep and fatigue were decreased with staying one day only at the hospital. While help giving at home from women's sisters was decreasing women’s sleep disturbances and fatigue compared with help from husband. There was a highly statistically significant positive correlation between sleep disturbance and fatigue. Recommendations: It was recommended that awareness program for women and nurses about caring for postnatal period and who are at risk of developing postnatal fatigue and sleep disturbances, and help them to cope with the difficulties encountered

Mai M Aly,1,&ast; Taghreed S Meshref,2,&ast; Marwa A Abdelhameid,3 Shimaa A Ahmed,4 Asmaa S Shaltout,5 Alaa Eldin Abdel-Moniem,2 Dina A Hamad2 1Clinical Hematology Unit, Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt; 2Critical Care Unit, Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt; 3Department of Internal Medicine, Faculty of Medicine, Aswan University, Aswan, Egypt; 4Department of Internal Medicine, Faculty of Medicine, Qena University, Qena, Egypt; 5Department of Medical Microbiology & Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt&ast;These authors contributed equally to this workCorrespondence: Mai M AlyClinical Hematology Unit, Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, EgyptTel +201223971678Email mai_heamatology@aun.edu.egIntroduction: Coronaviruses belong to a large family that leads to respiratory infection of various severity. Hematological ratios are indicators of inflammatory response widely used in viral pneumonia with affordability in developing countries.Purpose: Study the role of the neutrophil lymphocyte ratio (NLR), derived NLR ratio (d-NLR), platelet lymphocyte ratio (PLR), and lymphocyte monocyte ratio (LMR) in predicting the outcome of COVID-19 Egyptian patients.Methods: A retrospective study on 496 COVID-19 Egyptian patients, managed in four tertiary centers, grouped into non-severe, severe, and critical. Patients’ laboratory assessment including total leucocyte count (TLC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute monocyte count (AMC), NLR, d-NLR, LMR and, PLR were reported as well as C reactive protein (CRP), D-dimer and serum ferritin.Results: TLC, ANC, AMC, NLR, d-NLR and, PLR were highest in the critical group (p< 0.001 for all except AMC p=0.033), while this group had the least ALC and LMR (p=0.049 and < 0.001, respectively). Higher CRP and d-dimer levels were reported in the critical group (p< 0.001). At the same time, higher ferritin was found in the severe group more than the critical and non-severe groups (p< 0.001, p=0.005, respectively). We calculated the optimal cut-off values of the hematological ratio; NLR (3.5), d-NLR (2.86), PLR (192), and LMR (3). D-NLR had the highest specificity (89.19%), while NLR had the highest sensitivity (71.38%). By univariate logistic regression, age, DM, HTN, cardiovascular diseases, COPD, NLR, d-NLR, LMR and PLR, CRP, steroid, oxygen aids, and mechanical ventilation were associated with the severity of COVID-19. Still, only age, NLR, CRP, and oxygen aid were independent predictors in multivariate logistic regression.Conclusion: NLR is a predictor for severity in COVID-19. LMR, d-NLR, and PLR may assist in risk stratification.Keywords: COVID-19, NLR, d-NLR, LMR, PLR, Egypt

Coronaviruses belong to a large family of viruses that lead to respiratory infection of various severity. Hematological ratios are indicators of the inflammatory response that are widely used in viral pneumonia with affordability in developing countries. Aim: Study the role of the Neutrophil Lymphocyte ratio(NLR), derived NLR ratio(d-NLR), Platelet Lymphocyte ratio(PL/LR), and Lymphocyte Monocyte ratio(LMR) in predicting the outcome of COVID-19 Egyptian patients. Methods: A retrospective study on 496 COVID-19 Egyptian patients, managed in four tertiary centers; grouped into non-severe, severe, and critical. Results: Critical group of patients had the highest Total leucocyte count(TLC), absolute neutrophil count(ANC), absolute monocyte count(AMC), NLR, d-NLR and, PL/LR (pl0.001 for all except AMC p=0.03) in addition to the least absolute lymphocyte count(ALC) and LMR (p=0.04 and l0.001 respectively). We calculated the optimal cut-off values of the hematological ratio; NLR(3.5), d-NLR(2.86), PL/LR(192), and LMR(3). D-NLR had the highest specificity(89.2%) while NLR had the highest sensitivity(71.4%). By univariate logistic regression; age, DM, HTN, cardiovascular diseases, COPD, NLR, d-NLR, LMR and PL/LR, CRP, steroid, oxygen aids, and mechanical ventilation were associated with severity of COVID-19 but only age, NLR, CRP, and oxygen aid were independent predictors in multivariate logistic regression. Conclusion: NLR is a predictor for severity in COVID-19. LMR, d-NLR, and PL/LR may assist in risk stratification.

Topical minoxidil 5% are effective in androgenetic alopecia (AGA). Spironolactone acts as an androgen antagonist by competitively blocking androgen receptors. Studying the effect of topical minoxidil 5% gel and spironolactone gel 1% in management of AGA. The study includes 60 patients diagnosed as AGA; (group I): treated with topical minoxidil gel 5%, (group II): with topical spironolactone gel 1% and group (III) treated with combined minoxidil 5% and spironolactone 1% gel. All patients were followed up monthly throughout the treatment period. Scalp biopsy was taken before and after 12 months. In group I, the clinical response was in 90% of patients with variable degrees in improvement, in group II, the clinical response was in 80% of patients, meanwhile, in group III the clinical response was in all patients (100%). Histopathological examination of skin biopsy after treatment revealed significant increase in anagen hair on the other hand, both telogen and vellus hair was significantly decreased meanwhile, the T/V ratio was significantly increased. The results of this work revealed that topical minoxidil gel 5% and topical spironolactone gel 1% were effective in treatment of AGA, while the combination of two agents was better in treatment.

To compare the outcome for DBT-detected and DM-detected suspicious AD, to evaluate the risk of malignancy and if is affected by the US or MRI imaging correlation.All cases with suspicious AD (ultimately assigned BI-RADS 4 or 5 categories) were retrospectively included. Two radiologists independently reviewed DM and DBT images in two sessions for detection (DM vs. DBT). US and MRI imaging correlation findings were recorded. Pathologic results were compared between DBT-detected and DM-detected AD.Among 137 detected ADs, 103 (75.2%) were DM-detected, and 34 (24.8%) were only DBT-detected (p = 0.01). The malignancy rate was lower for DBT-detected than DM-detected AD (14.7% vs. 45.6%) (p = 0.01). Malignancy rate was higher with US-positive than US-negative correlation at DM-detected AD (49.4% vs. 27.8%) (p = 0.01). Malignancy rate was not different for DBT-detected AD with (16.7%) or without (12.5%) sonographic correlation. NPV based on radiologists' level of suspicion was high (86.2%-97.2%) but not sufficient enough to forgo biopsy. Of 34 sonographically occult ADs, a positive-MRI correlation was identified in 19 (55.9%) ADs (7 were malignant, 12 were benign). A negative-MRI correlation was identified in 15 (44.1%) ADs; all had a benign outcome (p = 0.01).DBT-detected AD is less likely to represent malignancy than does DM-detected; however, the risk of malignancy is not low enough to forgo biopsy. MRI-negative correlation in sonographically occult AD was significantly associated with benign outcomes and can avoid unnecessary interventions.

To assess the utility of MDCT tumor-vascular interface criteria for predicting vascular invasion and resectability in borderline pancreatic cancer (BRPC) patients after neoadjuvant therapy (NAT).This prospective study included 90 patients with BRPC who finished NAT, showed no progression in preoperative CTs and underwent surgery. Two radiologists independently assessed preoperative vessel-tumor interface criteria. The area under the ROC curve (AUC) was used to evaluate the diagnostic performance for predicting vascular invasions and resectability using surgical and pathological results as the gold standard. Inter-reader agreement was assessed using the κ coefficient.Pathologic vascular invasion was confirmed in 47 (54.7%) veins and 14 (16.3%) arteries. R0 resection was achieved in (82.6%71/86) pancreatic resection. Using criteria of circumferential interface ≥ 180 degrees with contour deformity ≥ grade 3 and/or length of tumor contact 2 cm to predict vascular invasion, the AUCs for the two readers were 0.85-0.88 for arterial invasion and 0.92-0.87 for venous invasion. Using criteria of circumferential interface ≤ 180° with contour deformity ≤ grade 2 and/or length of tumor contact 2 cm to predict R0 resection, the AUCs was 0.85-0.86 for the two readers. The overall inter-reader agreement was good (κ = 0.75-0.80). The κ values for venous invasion, arterial invasion and R0 resection were 0.76, 0.78, and 0.80.Tumor-vessel criteria demonstrated good diagnostic performance and reproducibility in the prediction of vascular invasion after NAT in BRPC. These criteria could be helpful in the prediction of R0 resection in cases with only venous involvement.