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Gestational diabetes is a prevalent condition that affects up to 24.2 % of women in South-East Asia. A study conducted in Iran highlighted the correlation between gestational diabetes and anxiety/depression. Improvements can be made by conducting a cohort study to better establish the causality between the compounding factors of mental health and gestational diabetes. Additionally, conducting a follow-up study in a region with a higher incidence of gestational diabetes, such as South-East Asia, can broaden the geographic distribution of the available data. We must promote awareness campaigns highlighting this correlation to improve holistic healthcare strategies.

Optimization algorithms exist to find solutions to various problems and then find out the optimal solutions. These algorithms are designed to reach desired goals with high accuracy and low error, as well as improve performance in various fields, including machine learning, operations research, physics, chemistry, and engineering. As technology continues to advance, optimization algorithms are increasingly needed to address complex real-world challenges and drive innovation across all disciplines. Quantitative leaps have been achieved in improving the efficiency of optimization algorithms through the diversity of sources of information feeding these algorithms according to the type of optimization problem, based on scientific and organized foundations. The objectives of this paper are to discuss the most important optimization algorithms, classify the scientific fields involved in their application, and optimize problems involved in this regard, in addition to providing a brief overview for comparison among these algorithms.

The term “inflammatory bowel disease” (IBD) describes a class of relapse-remitting conditions that affect the gastrointestinal (GI) tract. Among these, Crohn’s disease (CD) and ulcerative colitis (UC) are two of the most globally prevalent and debilitating conditions. Several articles have brought attention to the significant role that inflammation and oxidative stress cooperatively play in the development of IBD, offering a different viewpoint both on its etiopathogenesis and on strategies for the effective treatment of these conditions. Marine ecosystems may be a significant source of physiologically active substances, supporting the search for new potential clinical therapeutics. Based on this evidence, this review aims to comprehensively evaluate the activity of marine algae and deriving biomolecules in decreasing pathological features of CD and UC. To match this purpose, a deep search of the literature on PubMed (MEDLINE) and Google Scholar was performed to highlight primary biological mechanisms, the modulation of inflammatory and oxidative stress biochemical parameters, and potential clinical benefits deriving from marine species. From our findings, both macroalgae and microalgae have shown potential as therapeutic solutions for IBD due to their bioactive compounds and their anti-inflammatory and antioxidant activities which are capable of modulating markers such as cytokines, the NF-κB pathway, reactive oxidative and nitrosative species (ROS and RNS), trefoil factor 3 (TFF3), lactoferrin, SIRT1, etc. However, while we found promising preclinical evidence, more extensive and long-term clinical studies are necessary to establish the efficacy and safety of marine algae for IBD treatment.

Abstract Introduction The advent of new disease-modifying therapies (DMTs), such as monoclonal antibodies (mAbs), resulted in significant changes in the treatment guidelines for Multiple sclerosis (MS) and improvement in the clinical outcomes. However, mAbs, such as rituximab, natalizumab, and ocrelizumab, are expensive with variable effectiveness rates. Thus, the present study aimed to compare the direct medical cost and consequences (e.g., clinical relapse, disability progression, and new MRI lesions) between rituximab and natalizumab in managing relapsing-remitting multiple sclerosis (RRMS) in Saudi Arabia. Also, the study aimed to explore the cost and consequence of ocrelizumab in managing RRMS as a second-choice treatment. Methods The electronic medical records (EMRs) of patients with RRMS were retrospectively reviewed to retrieve the patients’ baseline characteristics and disease progression from two tertiary care centers in Riyadh, Saudi Arabia. Biologic–naïve patients treated with rituximab or natalizumab or those switched to ocrelizumab and treated for at least six months were included in the study. The effectiveness rate was defined as no evidence of disease activity (NEDA-3) (i.e., absence of new T2 or T1 gadolinium (Gd) lesions as demonstrated by the Magnetic Resonance Imaging (MRI), disability progression, and clinical relapses), while the direct medical costs were estimated based on the utilization of healthcare resources. In addition, bootstrapping with 10,000 replications and inverse probability weighting based on propensity score were conducted. Results Ninety–three patients met the inclusion criteria and were included in the analysis (natalizumab (n = 50), rituximab (n = 26), ocrelizumab (n = 17)). Most of the patients were otherwise healthy (81.72%), under 35 years of age (76.34%), females (61.29%), and on the same mAb for more than one year (83.87%). The mean effectiveness rates for natalizumab, rituximab, and ocrelizumab were 72.00%, 76.92%, and 58.83%, respectively. Natalizumab mean incremental cost compared to rituximab was $35,383 (95% CI: $25,401.09– $49,717.92), and its mean effectiveness rate was 4.92% lower than rituximab (95% CI: -30–27.5) with 59.41% confidence level that rituximab will be dominant. Conclusions Rituximab seems to be more effective and is less costly than natalizumab in the management of RRMS. Ocrelizumab does not seem to slow the rates of disease progression among patients previously treated with natalizumab.

Parkinson’s disease (PD) is recognized as the second most common neurodegenerative disease worldwide. Even if PD etiopathogenesis is not yet fully understood, in recent years, it has been advanced that a chronic state of inflammation could play a decisive role in the development of this pathology, establishing the close link between PD and neuroinflammation. In the broad panorama of inflammation and its several signaling pathways, the C-C chemokine receptor type 1 (CCR1) could play a key pathogenic role in PD progression, and could constitute a valuable target for the development of innovative anti-PD therapies. In this study, we probed the neuroprotective properties of the CCR1 antagonist BX471 compound in a mouse model of MPTP-induced nigrostriatal degeneration. BX471 treatments were performed intraperitoneally at a dose of 3 mg/kg, 10 mg/kg, and 30 mg/kg, starting 24 h after the last injection of MPTP and continuing for 7 days. From our data, BX471 treatment strongly blocked CCR1 and, as a result, decreased PD features, also reducing the neuroinflammatory state by regulating glial activation, NF-κB pathway, proinflammatory enzymes, and cytokines overexpression. Moreover, we showed that BX471’s antagonistic action on CCR1 reduced the infiltration of immune cells, including mast cells and lymphocyte T activation. In addition, biochemical analyses carried out on serum revealed a considerable increase in circulating levels of CCR1 following MPTP-induced PD. In light of these findings, CCR1 could represent a useful pathological marker of PD, and its targeting could be a worthy candidate for the future development of new immunotherapies against PD.

IntroductionBrucellosis is a zoonosis of major public health and economic importance that is endemic in livestock in Ethiopia with varying levels of seroprevalence.MethodsA cross-sectional study was carried out to determine the individual and herd-level seroprevalence of brucellosis in small ruminants in the Korahey zone of the Ethiopian Somali Region. A total of 324 sera from 63 herds of small ruminants were collected randomly using a multistage sampling technique and the sera were tested using the Rose Bengal Plate Test, and seropositive reactors were confirmed by the Complement Fixation Test.Results and discussionThe seroprevalence of brucellosis at the herds and the individual level was 6.35% (95% CI: 0.0–13%) and 1.23% (95% CI: 0.0–2%), respectively; with 1.4% in goats and 0.9% in sheep. Moreover, predicted variables like age group, parity, history of abortion, fetal membranes, herd size, ownership of other livestock species, contact with wild animals in the past year, the introduction of new animals in the past year, and lending of breeding males in the past year were not significantly associated (p > 0.05) with Brucella seropositivity at individual and herd level seroprevalence during multivariable logistic regression analysis. Pastoral community awareness regarding the public health impact of brucellosis and the promotion of an intersectoral One Health approach for the effective control of brucellosis is recommended.

Background: Gastrostomy tube can be inserted through a single incision without laparoscopic or endoscopic guidance. The superiority of this approach over the laparoscopic technique is still debated. Therefore, we aimed to compare single-incision open and laparoscopic gastrostomy in infants. Materials and Methods: We retrospectively reviewed paediatric patients aged 12 months or less who required enteral feeding between 2006 and 2019. Patients were grouped according to the technique into two groups. Group 1 (n = 42) included patients who had a single incision open gastrostomy, and Group 2 (n = 45) included patients who underwent laparoscopic gastrostomy. Results: The median age was 2 months (Q1-Q3: 1–4 months) in Group 1 and 5 months (3–6 months) in Group 2 (P < 0.001). Male presented 52.38% in Group 1 and 37.78% in Group 2 (P = 0.17). There were no differences in cardiac and neurological comorbidities between the groups. Operative time was significantly shorter in Group 1 (23 [20–25] vs. 40 [35–45] min; P < 0.001). There were no differences in the post-operative leak around the tube (P > 0.99), granulation tissue formation (P = 0.36), wound dehiscence (P = 0.61), surgical site infection (P > 0.99) and pneumonia (P = 0.10) between the groups. Conclusion: Single-incision open and laparoscopic gastrostomy could be effective and safe techniques in infants. The minimal anaesthesia without gas insufflation and short time for the open gastrostomy make it not inferior to laparoscopic gastrostomy and should be considered in small infants.

Background: The refractive errors are the most common cause of visual deterioration worldwide. Correction of refractive errors can be divided into optical & surgical methods with global tendency toward the surgical correction of refractive errors which is highly dependent on determining the central corneal thickness. Objectives: the study was done to assess the relation between the central corneal thickness corneal curvature and axial length of the eye in myopic, and hypermetropic patients. Patients and methods: The patients in this study were selected from the outpatient clinic of ophthalmology department, Qena University Hospital, South Valley University. The data collection sheet enclosed personal data (age, gender), visual acuity, refraction, keratometry, axial length of the eye, & central corneal thickness of 140 patients. Results: In this study most of the cases were females (65%) in the age group (7-39y). Myopia is the most common refractive error (68%). Increasing axial length of the eye is associated with increase in myopic refraction& mild flattening of corneal curvature. Steepening of corneal curvature is associated with mild decrease of the central corneal thickness. No significant correlation detected between axial length of the eye & central corneal thickness. Conclusion: Myopia is the most common refractive error. There is mild negative correlation between central corneal thickness & corneal curvature. Axial length of the eye has mild negative correlation with corneal curvature. While no significant correlation was detected between central corneal thickness & axial length of the eye.

Mesenteric cysts are rare benign intra-abdominal pediatric lesions. It has a variable clinical presentation from an asymptomatic mass to an acute abdomen that appears in the omentum or mesentery of the gastrointestinal tract. Abdominal ultrasound and complete surgical resection are the modality of choice for diagnosis and treatment. Here, we present 15 months old boy who presented to the emergency department with constipation and abdominal pain and was found to have a huge mesenteric cyst that was excised surgically.

In recent years, there has been growing recognition of the effectiveness of an all-gender-inclusive approach to peacekeeping missions in conflict zones, as highlighted in the UNSCR 1325 on Women, Peace and Security. UN has acknowledged the importance of female peacekeepers as potential role models for girls in male-dominated societies and has taken steps to increase their numbers. Pakistan has been a significant contributor to UN Peacekeeping missions over the past six decades and has also achieved the target of deploying female soldiers in its contingent forces. This study uses qualitative methods, primarily focus group discussions, to evaluate the constructive impact of UN female peacekeepers and their potential to enhance passive compliance towards International Humanitarian Law in conflict zones. It also explores whether female peacekeepers make a unique contribution and investigates the existing gap in research on their performance and the challenges they face in the field. The study highlights the need for further research and support to address the social and cultural factors that continue to restrict the contribution of female peacekeepers, particularly from countries like Pakistan, where women face significant challenges in the security sector. Bibliography Entry Malik, Salma, Ahmed Hasan Awan and Talha Ibrahim. 2023. "Role of Pakistani Female Peacekeepers in Enhancing International Humanitarian Law: Opportunities and Challenges." Margalla Papers 27 (1): 186-198.

Introduction: Coronavirus disease 2019 (COVID-19) is a serious pandemic affecting the global world since 2019 with heavy impacts on the social, economy, and normal daily life; one of the promising antiviral treatment used frequently all over the world is the remdesivir. Aim: The aim was to study the effect of 3–5 days remdesivir treatment course, regarding its starting time on clinical status and the fate of patients with COVID-19, with monitoring of the side effects. Materials and Methods: A prospective observational study involved 90 patients with COVID-19 who received remdesivir 5 days course; all were hospitalized, diagnosed by computerised tomography (CT) chest and polymerase chain reaction (PCR) at Merjan Teaching Hospital from August 2020 to October 2020. Those 90 patients’ age ranged from 25 to 88 years. Sixty-two patients received convalescent plasma with remdesivir against 13 patients who not received it. Tocilizumab was added for 18 patients, whereas 57 were not treated with it. Clinical state (SpO2, subjective dyspnea, respiratory rate (RR), fever, and the type of O2 supplements) of the patients was assessed three times. Regarding the time of starting remdesivir treatment during the course of disease, patients were assessed in three groups: patients received remdesivir within 15 days. Mean of the duration of patients discharge was recorded. Results: It showed an extremely significant difference (P < 0.001) between the discharged and both referred to respiratory care unit (RCU) and death patients. There were significant differences (P < 0.05) in the clinical state (SpO2, subjective dyspnea, RR, fever, and the type of O2 supplements) of the patients in all three times of assessments with significant correlation (P < 0.01) between means of the clinical state (SpO2 and subjective dyspnea score) and the fate (discharge, admission to RCU, and death) of patient who received it. There were no significant differences (P > 0.05) between means of time of starting therapy and the fate of patients. At the same time, no significant differences (P > 0.05) were seen in the mean of liver function test. There were no significant differences (P > 0.05) between the fate of patients who received convalescent plasma with remdesivir, but a significant disadvantage (P < 0.001) was seen in the fate of patient who received tocilizumab. Conclusion: We can conclude that remdesivir improves the clinical state of patients with COVID-19 regardless of the time of its starting during the course of disease.

Background: Globally, diabetes-related eye illness is the primary cause of visual impairment due to cataracts or retinopathy. The two most used visual field testing modalities in clinical practice are standard automated white-on-white (W-W) perimetry (SAP) and short wave length automated perimetry (SWAP). Objectives: To compare the value of short wave length automated perimetry SWAP (blue on yellow in contrast) to standard automated perimetry SAP in detecting changes in retinal sensitivity in diabetic individuals with or without retinopathy. Patients and methods: Forty eyes of forty patients divided into two groups, group (A) diabetic patients (20 eyes) without diabetic retinopathy and group (B) diabetic patients (20 eyes) with early diabetic retinopathy. The perimetry was done for all patients into two perimetry examination. First visit was for SAP and second visit was for SWAP. Results: In SAP, group II's MD (mean deviation) was considerably lower than group I's (P = 0.003). In SWAP, the MD in group II was considerably lower than in group I (P = 0.001). MD was substantially lower in SWAP than SAP in group I (P = 0.00009). In group II, the same results were obtained. Conclusions: In terms of distinction, the SWAP approach proved more sensitive and informative than the SAP technique.

Background: Anterior Segment Optical Coherence Tomography is the key tool to assess the corneal thickness. Pterygium is one of the most common ocular surface diseases. Our research about evaluation one of the corneal and conjunctival disorders with anterior segment OCT Objectives: Main purpose for our study is to evaluate corneal thickness before and after pterygium excision by anterior segment OCT. Patient and Methods: This study was performed between September 2020 and April 2021. Cases were recruited from outpatient clinic and inpatient wards of ophthalmology department in Qena University hospital. In each patient one eye was included in the study. Results: Our study included 40 patients of both sexes and evaluation of corneal thickness revealed that thickness preoperative is 862.2 ± 93.4 µm and one week post operative is 480.1± 57.9 µm and one month post operative is 500.4 ± 56.1µm .. Mean of corneal thickness pre-operative /post-operative one week was 382.05 ± 100.2 with statically significant relationship with P value =0.00.Mean of corneal thickness pre-operative /postoperative one month was 361.67 ± 102.6 with statically significant relationship P value =0.00.Mean of corneal thickness one month post-operative /one week post-operative 20.37± 24. 5 with statically significant relationship P value 0.00. Conclusion: This study revealed that corneal thickness decreased after pterygium surgery and after one week from surgery the epithelium completely healed to reach average normal thickness which is also affected by aging and some diseases.

This study was conducted in the lath house of the Department of Horticulture and Landscape Design/ College of Agriculture/ Tikrit University during the growing season of 2017 to investigate the effect of magnesium application and the foliar spraying of both gibberellic and salicylic acids on the vegetative growth characteristics of peach saplings CV. Miski, aged one year which were grafted on Apricot seedlings. Magnesium was added in three concentrations (0, 50 and 100 mg.litre-1) and was labelled as Mg0, Mg1 and Mg2 consecutively. The gibberellic acid was sprayed in three concentrations (0, 50 and 100 mg.liter-1) and labelled as GA0,GA1 and GA2 consecutively. Besides the salicylic acid was sprayed with the following concentrations (0, 100 and 200 mg.L-1) and labelled as SA0, SA1 and SA2 consecutively. All these processes were performed starting from April 10 three times, with a time interval of three weeks. The experiment was performed based on the split-plot system in Randomized Complete Block Design (RCBD) in which the various magnesium concentrations were added to the main plots and both the gibberellic and salicylic acids were applied to the subplots. The results showed that the addition of magnesium has positively increased the main stem diameter, single leaf area, total leaves area per plant and the relative chlorophyll concentrations in leaves. The height and the diameter of a sapling, length of the branches, leaf area and total leaves area of sapling were increased as a result of foliar spraying with gibberellic acid. The spraying of salicylic acid has a positive effect on the saplings’ characteristics (leaf area, total leaves area and relative chlorophyll concentration in leaves). The dual or triple interaction treatments between the three studied factors had the positive results in most characteristics were investigated.

Objective: To evaluate vertigo control and auditory rescue in patients with Meniere's disease treated with intratympanic Gentamicin and Dexamethasone. Study Design: Randomized Control Trial (Clinical Trials. gov Identifier: NCT05355610). Place and Duration of Study: ENT Departments CMH Quetta and Benazir Bhutto Hospital Rawalpindi Pakistan from Apr 2020 to Mar 2022. Methodology: Ninety-three cases of unilateral Meniere's disease meeting the inclusion criteria were treated with intratym-panic Gentamicin and Dexamethasone. Pre and post-treatment vertigo was assessed on Vestibular Deficit Index. Speech discrimination scores for auditory impact were also recorded pre and post-treatment. Results: In the Ninety-three treated cases, there was a statistically significant improvement in the Vestibular Deficit Index (with a p-value of 0.001). Although all patients had a reduced speech discrimination score, it was not statistically significant (p value=0.08). Conclusion: Control of vestibular symptoms can be achieved with intratympanic Gentamicin, and at the same time, the auditory system can be rescued with Dexamethasone.

Thyroiditis is a broad term that refers to a variety of clinical conditions marked by inflammation and damage to thyroid cells. These disorders could be caused by due to factors, including radiation, a microbial infection, or be linked to autoimmune thyroid disease, such as in Hashimoto thyroiditis (HT). This cross-sectional study aimed to the detection of anti-TPO antibodies and to investigate (Parvovirus B19) IgM and IgG antibodies in serum of patients to investigate their role in the pathogenesis of thyroiditis. The study included 91 patients suffering from thyroid dysfunction and diagnosed by performing of the thyroid hormone tests (FT3, FT4 and TSH) by Snibe Maglumi-800 Chemiluminescence Immunoassay, where they were divided into three groups namely (subclinical thyroiditis, hypothyroidism and hyperthyroidism). Then Moreover, the study investigates the determination which of them has HT by the detection of thyroid autoantibodies anti-TPO Ab and the detection of antibodies to specific (Parvovirus B19) IgM and IgG in the sera of patients by ELISA. The results of serology showed that the percentage of anti-TPO antibodies in the three investigated groups was (54.94%), and the highest percentage was in the hypothyroidism group, which amounted to (71.40%). The serological diagnosis also showed that the presence of antibodies to (Parvovirus B19) IgM was (90.10%) while, IgG levels were (100%) respectively. Conclusions: Parvovirus B19 infection is commonly seen in patients with thyroiditis.

Abstract Background Re-exploration of bleeding after cardiac surgery is associated with significant morbidity and mortality. Perioperative blood loss and rate of re-exploration are variable among centers and surgeons. Objective To present our experience of low rate of re-exploration based on adopting checklist for hemostasis and algorithm for management. Methods Retrospective analysis of medical records was conducted for 565 adult patients who underwent surgical treatment of congenital and acquired heart disease and were complicated by postoperative bleeding from Feb 2006 to May 2019. Demographics of patients, operative characteristics, perioperative risk factors, blood loss, requirements of blood transfusion, morbidity and mortality were recorded. Logistic regression was used to identify predictors of re-exploration and determinants of adverse outcome. Results Thirteen patients (1.14%) were reexplored for bleeding. An identifiable source of bleeding was found in 11 (84.6%) patients. Risk factors for re-exploration were high body mass index, high Euro SCORE, operative priority (urgent/emergent), elevated serum creatinine and low platelets count. Re-exploration was significantly associated with increased requirements of blood transfusion, adverse effects on cardiorespiratory state (low ejection fraction, increased s. lactate, and prolonged period of mechanical ventilation), longer intensive care unit stay, hospital stay, increased incidence of SWI, and higher mortality (15.4% versus 2.53% for non-reexplored patients). We managed 285 patients with severe or massive bleeding conservatively by hemostatic agents according to our protocol with no added risk of morbidity or mortality. Conclusion Low rate of re-exploration for bleeding can be achieved by strict preoperative preparation, intraoperative checklist for hemostasis implemented by senior surgeons and adopting an algorithm for management.

Background: Biomarkers for diagnosing the occurrence and development of hyperthyroidism constitute a major worldwide clinical scrutiny. Evidence is continuing in an investigation about the most relevant biomarkers in developing the disease. Objective: To discover and correlate the most dependent biomarkers in developing hyperthyroidism in both genders. Patients and Methods: In the present study, two groups were included, the first group: forty males and females with chronic hyperthyroidism were enrolled. Serum levels of thyroid hormones, lipid profile, oxidative stress marker, blood glucose, and renal function markers were measured and compared with euthyroid subjects. Results: The present study revealed that referral biomarkers were varied between genders with a remarkable association of hyperthyroidism with serum cholesterol, triglycerides, and low-density lipoproteins in females, while nitrites and creatinine and MDA were significantly correlated in male patients. Conclusion: In this study, we found that indicating biomarkers for hyperthyroidism could be differentially changed in different genders that help in understanding the progression and development of the disease.

Objective: To analyze the results of pure tone audiometry in the terms of age, sex, and type of hearing loss attending the hospital with the complaint of hearing loss. Materials and Methods: In this descriptive study, patients attending Benazir Bhutto hospital with complaints of hearing loss were included. The data analysis was done under the terms of age, sex and unilateral/bilateral, and type of loss after pure tone audiometry of every case. The type of hearing loss was determined as conductive, SNHL, and mixed hearing loss. Results: There were 47 patients. Males were 34 (72.34%) outnumbering13females 13(27.66). Adults were44 (93.61%) and children were 3(6.34%). Mixed hearing loss was28 (59.57%)% compared to conductive hearing loss 15 (31.91) and SNHL4 (8.51%). Conclusion: Hearing loss is more common in adults and more prevalent in males. It is mostly bilateral. Mixed hearing loss is more common as compared to conductive and SNHL respectively. Sociacusis is to be taken seriously.

Objective: To determine association of anosmia as an early symptom of COVID-19 infection. Study Design: Comparative cross sectional study. Place and Duration of Study: ENT department, Combined Military Hospital, Quetta, from Apr to Oct 2020. Methodology: A total of 6411 consenting patients with symptoms of viral upper respiratory tract infection presenting at ENT department, Combined Military Hospital Quetta, from Apr to Oct 2020 were tested for COVID 19 via PCR studies. Results: Out of 6411 individuals 1109 (17.3%) were found to be COVID positive and 5302 (82.7%) were COVID negative. Of the COVID positive cases 611 (55.1%) of COVID positive individuals had anosmia, whereas only 68 (1.2%) of COVID negative individuals had anosmia, this observation was statistically significant (p0.05 on chi square test). Conclusion: Anosmia has a definite association with COVID 19 infection.

Objective: We aimed to study the long-term association of LV mass index (LVMI) and myocardial fibrosis with ventricular arrhythmia (VA) in a population of patients with confirmed hypertrophic cardiomyopathy (HCM) using cardiac magnetic resonance imaging (CMR). Methods: We retrospectively analyzed the data in consecutive HCM patients confirmed on CMR referred to an HCM clinic between January 2008 and October 2018. Patients were followed up yearly following diagnosis. Baseline demographics, risk factors and clinical outcomes from cardiac monitoring and an implanted cardioverter defibrillator (ICD) were analyzed for association of LVMI and LV late gadolinium enhancement (LVLGE) with VA. Patients were then allocated to one of two groups according to the presence of VA (Group A) or absence of VA (Group B) during the follow-up period. The transthoracic echocardiogram (TTE) and CMR parameters were compared between the two groups. Results: A total of 247 patients with confirmed HCM (age 56.2 ± 16.6, male = 71%) were studied over the follow-up period of 7 ± 3.3 years (95% CI = 6.6–7.4 years). LVMI derived from CMR was higher in Group A (91.1 ± 28.1 g/m2 vs. 78.8 ± 28.3 g/m2, p = 0.003) when compared to Group B. LVLGE was higher in Group A (7.3 ± 6.3% vs. 4.7 ± 4.3%, p = 0.001) when compared to Group B. Multivariable Cox regression analysis showed LVMI (hazard ratio (HR) = 1.02, 95% CI = 1.001–1.03, p = 0.03) and LVLGE (HR = 1.04, 95% CI = 1.001–1.08, p = 0.04) to be independent predictors for VA. Receiver operative curves showed higher LVMI and LVLGE with a cut-off of 85 g/m2 and 6%, respectively, to be associated with VA. Conclusions: LVMI and LVLGE are strongly associated with VA over long-term follow-up. LVMI requires more thorough studies to consider it as a risk stratification tool in patients with HCM.

Backgroud: Extreme alterations in hematological values and inflammatory biomarkers affecting dependent variables in clinical tests are associated with type-2 diabetes mellitus and anemia. Objective: To investigate some hematological and inflammatory risk factors and their relation in developing insulin resistance in anemic type-2 diabetes mellitus. Patients and Methods: This case-control study was conducted in 190 patients and healthy subjects in the hospital of Layla Qasim Center in Erbil city and ethical clearance was obtained from the university ethical review committee. The included subjects were divided into three groups: non-diabetic (control) group, non-anemic type-2 diabetes mellitus, and anemic type-2 diabetes mellitus. Blood samples were analyzed for hematological parameters by Coulter counter analyzer, and biochemical tests included glycated hemoglobin, fasting blood glucose, insulin, and some inflammatory biomarkers by spectrophotometry and standard sandwich enzyme-linked immunoassay. Harvested data were analyzed by the statistical package for social science version 23. Results: The results showed remarkable alterations in glycated hemoglobin, red and white blood corpuscles, and inflammatory parameters in anemic type-2 diabetes mellitus compared to non-anemic type-2 diabetes mellitus. Inflammatory parameters including interleukin-1 and tumor necrosis factor-alpha exhibited a strong positive correlation with anemic diabetes than non-anemic diabetes. Conclusion: We concluded that some hematological and biochemical parameters were positively related to developing anemic type-2 diabetes mellitus and can be helpful as diagnosing tools for predicting the progression of anemic type-2 diabetes mellitus.

Iris recognition indicates the procedure of recognizing humans based on their both left and right iris patterns. Nowadays there is rapid progress in realizing an old dream of developing a user-friendly recognition system. Most of the new projects became a nightmare of security of the system. The prosperity of iris recognition aside from its attractive physical characteristics is led to developing an efficient feature extractor to attain the required objective of recognition. Fingerprint, facial, and iris biometric techniques are developed widely for identifying processing most boarded management points, access control, and military checkpoints. Hybridization between Daugman’s Integro Differential Operator (IDO) with edge base methods was realized through taking the advantages of the good qualities of both methods so as to enhance the precision and reduce the required time. The proposed hybrid recognition system is very reliable and accurate. UBIRIS version 1 dataset was utilized in the conducted simulation which indicates the distinctions of the hybrid method in providing good performance and accuracy with reducing the time consuming of iris localization by approximately 99% compared with IDO and edge based methods.

Arabic excelled other Semitic languages by bestowing new meanings on the term (love), meanings that transcended the sensual aspects of the term. More importantly, the term (love) occupied a central position in the Arabic language, and it also underwent deep religious, spiritual, and philosophical developments. Quranic verses and Prophetic traditions left their impact at an early stage (in the first and second centuries after Hijra) on the formulation of the mystical language of love (the language of spiritual experience). It is worth noting that the rich and unique Arabic vocabulary enabled mystics to express the slightest shades of human emotions, related to love in general and divine love in specific. The etymology of the word love and its different derivations enjoy a central status in Arabic as well as in Sufism. As such was born a new language never known to pre-Islam Arabs, a language distant from the dominant forms of Classical Arabic literature. It was the language of love (the language of spiritual experience to mystics), a language that emerged from the start without external cultural sources or influences in order to express the originality of the spiritual experience of Islam. Having undergone a certain development, such language of love as well as the spiritual experience it carries became the main component, and even the goal, of any work in Muslim Sufism starting from the 3rd Hijri century. تميزت اللغة العربية عن مختلف اللغات السامية الأخرى بإعطائها معاني جديدة لکلمة (حب)؛ معاني متسامية عن الجوانب العاطفية الحسية، بل والأهم من ذلک أن کلمة (حب) وجدت مکانة مرکزية في اللغة العربية من ناحية، ثم خضعت لتطورات دينية وروحية وفلسفية عميقة من ناحية أخرى. ولقد أثرت الآيات القرآنية والأحاديث النبوية على تشکيل لغة الحب (لغة الخبرة الروحية) على صوفية الإسلام في مرحلة مبکرة (في القرنين الأول والثاني الهجريين). کما أن مفردات اللغة العربية الغزيرة والفريدة والمتميزة قد ساعدت المتصوفة على التعبير عن أدق خلجات المشاعر الإنسانية المرتبطة بالحب عامة، والحب الإلهي خاصة، فالجذر (ح- ب- ب) بمختلف مشتقاته له مکانة مرکزية في اللغة العربية عامة، وفي التصوف الإسلامي خاصة. ومن هذا المنطلق تم ميلاد لغة جديدة؛ لغة لم تکن معروفة عند العرب قبل الإسلام، لغة بعيدة عن الشکلية السائدة في الأدب العربي القديم، ألا وهي لغة الحب (لغة الخبرة الروحية عند الصوفية)، لغة نشأت- في بدايتها- دون أي مصادر ثقافية خارجية، لتعبر عن أصالة التجربة الروحية في الإسلام. وبتطور لغة الحب (لغة الخبرة الروحية) أصبحت هذه (اللغة) و(الخبرة الروحية) المکون الرئيسي- بل والهدف أيضا- لأي کتاب في التصوف الإسلامي ابتداءً من القرن الثالث الهجري، مما يجعل مجال هذا البحث واسع للغاية، لذلک فسنحاول في هذا البحث تسليط الضوء على بعض السمات الأساسية فقط، في محاولة رسم مخطط عريض للسياق التاريخي الذي قدمه الصوفية في هذا المجال، من خلال العناصر التالية: - مقدمة. - الحب في حرکة الزهد الأولى (القرنين الأول والثاني الهجريين/ السابع والثامن الميلاديين). - بدايات الحب الخالص (القرن الثاني الهجري/ القرن الثامن الميلادي): رابعة العدوية. - نحو تصوف الاتحاد: الحلاج. - الحب في التصوف السني: الغزالي. - الحب في التصوف الفلسفي: ابن العربي. - الخاتمة.

Background Data: Sacral fractures constitute a major entity of pelvic fractures. 50% of these sacral fractures are not recognized on initial physical examination of the traumatized patients. The most important prognostic factor in management of sacral fractures is the presence or absence of neurological deficit. Some studies adopt the concern regarding fixation of sacral fractures in poly-traumatized patients to avoid systemic effects and complications of recumbency. Purpose: Evaluation of the efficacy and safety of the minimally invasive percutaneous ilio-sacral fixation technique in management of initial twenty cases of sacral fractures at department of Neurosurgery in Alexandria University. Study Design: Retrospective clinical case cohort study. Patients and Methods: Between March 2017 and January 2019; 20 patients were presented at Neurosurgery Department in Alexandria University hospitals with traumatic sacral fractures. They were 13 males and 7 females with the mean of 34 years (ranged from 18-55 years). Plain X ray of pelvis including antero-posterior, inlet and outlet views of pelvis, CT scan with 3D reconstructions were done. We used Dennis classification and Roy-Camille classification in our study. Stabilization of sacral fracture was done percutaneously using 7 mm cannulated partially threaded ilio-sacral screws. Clinical, neurologic and radiographic examinations were performed in the follow up period (6 months) to assess healing, evaluate clinical improvement and to detect any implant changes. Results: Total 39 percutaneous ilio-sacral screws were placed in 20 patients. Partially threaded cancellous 7.0-millimeter cannulated screws were used. Fifteen patients had unilateral double screws; one patient had unilateral triple screws; two patients had bilateral single screws for bilateral sacral fracture and two patients had unilateral single screw. Two Misplaced screws out of thirty-nine screws were found in the post-operative CT. One patient developed post-operative foot drop. All fractures healed clinically and radio-graphically except one case fixed by single screw and did not show radiological healing. Conclusion: Percutaneous ilio-sacral fixation for sacral fractures is a safe minimally invasive method for management of sacral fractures. It is effective regarding pain relief with high fusion rate. It needs a long learning curve. Single screw fixation is not a rigid fixation and may lead to hardware failure. (2019ESJ193)

Modelling can provide intellectual frameworks that are necessary to translate data into knowledge. Mathematical modelling has played an important role in many applications, such as ecology, genetics, engineering, psychology, sociology, physics and computer science, in recent years. This study focused on reviewing mathematical modelling and its applications to biological systems by tracing many metabolic activities of cellular interactions on the one hand and between the spread of epidemics and population growth on the other hand. Various mathematical equations have played fundamental roles in the formation of these systems for model development procedures by describing them mathematically and establishing relationships that characterise the dynamics of a biological phenomenon. Consequently, the creation of new mathematical representations and simulation algorithms is important to the success of biological modelling initiatives. Finally, the optimisation approach performs its primary role in directing and controlling interactions by adjusting the parameters that provide the best possible result for the system

Objective: To determine the role of Rosuvastatin as a possible treatment of sudden sensorineural hearing loss. Study Design: Quasi-experimental study. Place and Duration of Study: ENT Departments, Combined Military Hospital Quetta & Combined Military Hospital Lahore, from Apr 2015 to Sep 2017. Methodology: This quasi-experimental study performed at Combined Military Hospital Quetta & Combined Military Hospital Lahore comprised of seventy-eight patients of sudden sensorineural hearing loss (SSNHL) having hyperlipidemia. Patients pre-treatment total serum cholesterol was measured, and hearing loss in speech frequencies was recorded on audiometry. The seventy-eight patients were administered tablet Rosuvastatin 10mg once daily with low fat diet for 4 months. On completion of 4 months of treatment, patients were selected by using non probability purposive sampling and divided into responder and non-responder group depending on total serum cholesterol levels. Post treatment total serum cholesterol levels and improvement in hearing levels were also recorded and graded according to siegel’s criteria. Results: Total serum cholesterol came to within normal limits in 43 (55.1%) patients (responder), while it remained high in 35 (44.9%) patients (non-responder group). Improvement in hearing scores was assessed using siegel’s criteria. pearson chi square test showed statistically significant improvement (p=0.001) in hearing scores among responder group as compared to non-responder group. Conclusion: Sudden sensorineural hearing loss, in patients having hyperlipidemia, can be managed by treating hyperlipidemia with lipidlowering agent rosuvastatin.

This study aimed to evaluate the necessity for silicone tube insertion following endonasal endoscopic dacryocystorhinostomy (DCR), and the optimal time for its removal. A prospective study was done at Al-sadr Teaching and Al-Shafaa General Hospitals in Basrah, Iraq on seventy two patients with nasolacrimal duct obstruction diagnosed and referred from ophthalmologist to ENT clinic. Preoperative assessment with investigations were done and all patients were subjected to endoscopic endonasal DCR. The patients were divided into three groups; the first group included those with long period stenting (silicone tube removed three months or more), the second group included those patients with short period stenting (tube removed 2-3 weeks after surgery), and the last group included those with no silicone tube stenting. The success rate and complications after surgery were studied in each group for more than one year. The 72 patients were; 63 females (87.5%) who affected more than males (9, 12.5%). the most common age group was 21-45 years. Left side of disease 41(56.9%) is more than right side 31(43.1%). Sixty eight operations (94.4%) out of 72 were primary surgery while four (5.6%) were revision surgery. Ancillary procedures were done also; 13 (18%) septal surgery and 3(4.1%) endoscopic sinus surgery. Success rate was more among short period stenting group 22 out of 24 (91.6%), then without stenting group 19 (82.6%) and those with long period stenting was only 20 from 25 (80%). In conclusion, no statistical significant difference (benefit) about the usage or not of the silicone tube and also about how long keeping the tube, but it is preferable to use silicone tube (for 2-3 weeks only) to improve success rate. Keywords: Silicone tube, Insertion, Endonasal, Endoscopic, Surgery

BackgroundRabies remains a neglected and poorly controlled disease throughout the developing world, particularly in Africa and Asia, where most human rabies deaths occur. ObjectiveThis study aimed to describe the epidemiology of rabies exposures, its trend, and its geographical distribution in Yemen. MethodsCumulative data from a rabies surveillance system for the period 2011-2017 were obtained from the National Rabies Control Program as paper-based annual reports. Data included the number of persons bitten by a suspected rabid animal, their gender and age, and the result of the animal’s laboratory test. Human cases were defined as those exposed to rabies virus bitten by a suspected rabid animal, exposed to a confirmed rabid animal and then received postexposure prophylaxis (PEP), and deaths occurred after exposure to a confirmed rabid animal after having rabies symptoms during 2011-2017. ResultsFrom 2011 to 2017, a total of 76,049 persons were bitten by a suspected rabid animal. Of these, 21,927 (28.83%) were exposed to positively confirmed rabid animals and then received PEP, and 295 (0.38%) rabies-related deaths occurred. Of all cases with rabies exposure, 50,882 (66.91%) were males. The most affected age group by animal bites (31,816/76,041, 41.84%), positive exposure (8945/21,927, 40.79%), and rabies deaths (143/295, 48.47%) was 5-14 years. Rabies vaccines and immunoglobulins quantities were least available in 2016 and 2017. The annual incidence rate of exposure to animal bites and rabies exposure was 50 and 14 per 100,000, respectively. The annual mortality rate was 2 per 1,000,000. The highest incidence rate of animal bites was in Dhamar (112 per 100,000) and Ibb (94 per 100,000), whereas the highest incidence of exposed cases was in Amanat Al Asimah (40 per 100,000) and Ibb (37 per 100,000). Mortality rate was the highest in Amanat Al Asimah (6 deaths per 1,000,000) followed by Ibb and Dhamar (4 deaths per 1,000,000 in both). ConclusionsRabies remains a worrying health problem in Yemen with higher percentage reported among children and males. Targeting school-age populations by education, communication, and information campaigns about preventive measures is strongly recommended. An electronic system should be introduced to improve reporting. It is important to have a sufficient supply of vaccines and immunoglobulins in control units, especially in the at-risk or impacted governorates. Future studies are suggested to determine incidences and risk factors of disease progression.

ABSTRACT Background: Nasal obstruction is a common presenting problem which can lead to symptoms like sleep disturbances, mouth breathing, oral cavity dryness. Hypertrophied inferior turbinate is a common cause of nasal obstruction. Microdebrider assisted turbinoplasty and submucosal diathermy are widely used methods for patients who fail to respond to medical therapy to relieve obstruction. The aim of the study was to compare two methods in terms of relief of nasal obstruction, reduction in sneezing and post-operative complications. Material & Methods: This randomized clinical trial was conducted at ENT Department, Benazir Bhutto Hospital Rawalpindi, Pakistan for one year from 01-03-2018 to 28-02-2019. One hundred and twenty patients were randomized to into either MAT and SMD groups each with 60 patients. Nasal obstruction symptom evaluation score system (NOSE) was used to access relieve from obstruction and sneezing. SPSS 22, online chai square and fisher exact test calculators were used to analyze the data. Results: Two groups were comparable for age and gender. After 3 months of treatment, all patients in MAT group and 51 patients in SMD group were completely relieved from obstruction. At two weeks follow up 37(61.57%) patients in MAT group had grade 0 obstruction compared with 14 (23.33%) in SMD group and this difference was significant (p value .000). at one month follow up 55 (91.67%) patients in MAT while 46 (76.67%) had completely relieved obstruction and this difference was significant ( p value .024). Not all patients showed reduction in sneezing in both groups. 37 patients in MAT and 25 patients in SMD group had completely relieved from sneezing at third month follow up with MAT group showing significantly more patients with sneezing reduced at one month follow up. Crust formation was most seen complication in both groups, more with SMD group at two weeks follow up which responded to treatment alkaline nasal douches and crust removal. Conclusion: MAT gives better in terms of nasal obstruction relieved, reduction in sneezing and less complications than SMD procedure. KEYWORDS: Microdebrider; Diathermy; Turbinates; Nasal obstruction

Coronavirus pandemic, is a progressing worldwide pandemic of coronavirus disease 2019 (COVID-19), brought about by sever acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The episode was first distinguished in Wuhan, China, in December 2019. The World Health Organization announced a Public Health Emergency of International Concern on 30 January 2020, and a pandemic on 11 March. Scientists around the world are working to establish an effective treatment against SARS-CoV-2 to control the spread of this pandemic. In this review, we summarized the potential therapeutic strategies for treatment of COVID-19 and dividing the treatments to several categories including antiviral drugs which act on decreasing the viral load inside the body of patients, immunotherapy and immunomodulatory which relive the inflammatory process of viral infection. DOI: http://dx.doi.org/10.5281/zenodo.4342351

The elevated inflammatory cytokines suggest that a cytokine storm, also known as cytokine release syndrome (CRS), may play a major role in the pathology of pandemic Coronavirus Disease (COVID-19) leading to cause Acute respiratory distress syndrome (ARDS) and multiple organ dysfunction then death. However, there was a controversial efficacy of corticosteroids in the treatment of COVID-19 induced cytokine release syndrome (CRS). Novel therapies to treat COVID-19-induced CRS become urgent needed. One of the most common cytokine that showed to be critical in the COVID-19 is the IL-6 and this article discuss the pathogenesis of this cytokine in severe acute respiratory syndrome (SARS). Also, this article proposes to utilize interleukin-6 (IL-6) blockade and potential therapeutic effect of IFN-γ to manage COVID-19-induced CRS and discuss several factors that should be taken into consideration for its clinical application. DOI: http://dx.doi.org/10.5281/zenodo.4004241

Background It is well known that alloimmunization to red blood cell antigens resulting from the genetic disparities between the donor and the recipient is one of the risks of blood transfusion. Alloimmunization can result in clinical hemolysis and difficulty in cross-matching blood. The risk of alloimmunization is higher in patients who have received multiple blood transfusions such as renal failure patients on dialysis who receive blood transfusions. The antibody-screening test (2–3 cells panel) used to detect unexpected antibodies is not a mandatory pretransfusion testing in our blood bank of National Institute of Urology and Nephrology (NIUN), and is performed routinely in limited blood centers. Aim This study was conducted to screen and identify different types of red cell alloantibodies and the factors influencing the development of alloantibodies among patients on dialysis in NIUN. Patients and methods This study was conducted in the blood bank of NIUN, Egypt. A total of 192 patients (102 males and 90 women) who were diagnosed to have chronic renal failure, on regular hemodialysis for at least 1 year, their age more than 20 years, anemic (hemoglobin

This research article is mainly concerned with the dialectic of art and theology with reference to Peter Shaffer’s play “Amadeus.” It delineates comparing divine and artistic creativity as a vital segment of the Greek theology and philosophy of art, and the Christian religious beliefs. The divine forces of the antiquated Greek pantheon are divided into different classifications. In their theology, art and many other concepts of life are not man-made; humans are nothing but tools of several gods, and those gods inspire them to present their arts through these tools and in several forms. Christians think about God and artist in a like manner discourse postulating that God resembles an artist who utilizes his creative energy and makes a universe of rich differing qualities; hence, they likewise do as such in their more scholarly and philosophical compositions.

Background: Friedreich ataxia (FRDA) is the most common form of inherited ataxia, comprising one-half of all hereditary ataxias with a carrier rate between 1 in 60 to 1 in 90 and with a disease prevalence of 1 per 29,000. It can occur in two forms the classic form or in association with a vitamin E dependent ataxia. The precise role of Vitamin E in the nervous system is unknown; An Oxidative attack is suspected to play a role in Ataxia with Vitamin E deficiency, as well as in Friedreich ataxia. Vitamin E is the major free-radical-trapping antioxidant. Objective: Theobjectives of the study is to asses vitamin E level in patients with Friedreichs ataxia phenotype in Iraqi patients. Type of the study:Cross-sectional study. Method: This study was conducted at the neuroscience hospital and Baghdad teaching hospital during the period from the 1st of November 2013 through November 2014. Forty patients with friedreich's ataxia attended in neuroscience hospital and Baghdad teaching hospital during this period; there was12 male, 20 female patients and their age range between (4-50) years. Results: Regarding the level of vitamin E in patients in the present study, The study revealed that mean level of vitamin E for Friedreich ataxia patients was (10.92 μg/ml) ranging from (8-18 μg/ml),while in the control group the mean was (28.06μg/ml) ranging from (22-36μg/ml), the difference in mean level was found to be statistically significant (p=0.0001.) Thirty percents of (FRDA) patients was (8-9.9μg/ml), while half of patients (50%) were within (10-11.9 μg/ml),and low percentage (15 %)of patients were within (12-13.9 μg/ml ). The rest (5%) were had vitamin E level equal or more than 14 μg/ml. these finding revealed that majority of Friedreich ataxia patients were found with low level of vitamin E (32 patients(80%)), and low percentage with normal level (8 patients(20%.)) Patients with Friedreich ataxia were found to have a comparable level 10.47±1.79(8.4-13.5),11.48±2.61(9.4-18) and 10.66±1.26(9-12.5) for those with less than 10 years, 10-19 years , equal or more than 20 years of age respectively (p=0.382), while it was found to have a significantly decreasing level with advance in the age for the control group, 30.57±4.61(24.5-36), 27.46±3.16(23.7-33.5), 25.50±3.03 (22.9-29) for those less than 10 years, 10-19 years, 20 years or more respectively (p=0.006.) Vitamin E level in relation to Gender showed that Friedriech ataxia male patients had significantly higher vitamin E level compared to females [12.05±2.66 (9.0-18.0) compared to 10.17±1.07 (8.4-12.0)] (p=0.003), while relation to gender in the control group was not of significant value statistically [27.08±2.90 (22.9-30.0) for male compared to 29.04±4.97 (23.7-36) for females] , p=0.136. Conclusion: In the light of the results of the present study, the following conclusions were made: The level of vitamin E in friedreichs ataxic phenotype patients was subnormal than normal range representing 80% of the sample selected for the test. The level of vitamin E in male patients of freidriechs ataxic phenotype patients was higher than female patients.

Removal of heavy metals from water and wastewater has received a great deal of attention. Froth flotation technique is one of the most technologies being used for treatment of polluted water, where it considered low cost process than others. This study records lab scale experiments to test efficiency of multistage froth flotation column in removing a heavy metal, (Pb fine particles less than 45 µm) from wastewater of battery industry. Solutions concentration of Pb (100ppm) was prepared and passed through flotation column. The removal efficiency was quite high for Pb ranging from 62.4-96.3% and maximum removal occurred at frother concentration (20 ppm) and superfacial gas velocity (4 cm/sec), where caprylic acid and hexanol are used as frother in this study. Attempts made to analyze the kinetic behavior of the process indicate that it follows the first-order classical rate equation for the kinetic of froth flotation process. In the proposed equation, values of the constants correlation coefficient (R) and kinetic flotation constant (k), evaluated from the experimental results then (k) related to the frother dosages and superfacial gas velocity.