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Background Children often suffer from congenital or acquired diseases. Ambulatory cases represent the vast majority of pediatric surgical cases. COVID-19 pandemic-associated regulatory precautions had made the process of seeking medical advice at a suitable appointment such a big problem. We utilized telemedicine (online encounter) to deliver the required healthcare service for sorting and guiding pediatric ambulatory surgical patients. In this article, we aimed to: (1) present our experience, (2) evaluate the effectiveness, and (3) document the results of this technology to solve the problem of difficult healthcare accessibility. Materials and Methods In this study, we compared the utilization of telemedicine (virtual clinic via video consultation) prospectively in the current era of the COVID-19 pandemic in the period from June 2020 to July 2021 to the in-person clinic encounter at the outpatient department (OPD) retrospectively in the previous year (from June 2019 until the end of May 2020) for perioperative management of pediatric ambulatory surgical patients. The study was conducted at 3 tertiary care pediatric surgery centers. The information recorded for analysis included: demographic data, surgical condition distribution, time interval from the appointment request till the actual encounter with the surgeon, conversation duration, distance traveled, and ultimate fate of the consultations. For both groups, service was evaluated after the first follow-up visit by a patient survey questionnaire (Patient Experience Assessment form) including questions relevant to each encounter. Results A total of 1124 pediatric patients with various ambulatory surgical conditions had been scheduled for virtual clinic video encounters. Of them, 1056 cases were evaluated by video consultation, supervised by their parents or caregivers, thus, achieving an attendance rate of 94%. Of the remaining cases, 2% (n=23) were canceled and 4% (n=45) did not attend the virtual clinic. Two-thirds of the cases live in rural /remote areas. Patients’ overall satisfaction was 92%. This was in comparison to 872 pediatric ambulatory surgical patients scheduled for in-person clinic visits before the implementation of the virtual clinic. Of them, only 340 cases had attended the clinic, thus, achieving an attendance rate of 39%. Of the remaining cases, 450 cases (51.6%) were canceled and 82 cases (9.4%) did not attend the clinic (no show). About 48% of the cases live in rural areas. For this group, patients’ overall satisfaction was 63%. The mean encounter duration was similar for both groups (∼ 5 minutes). Surgical condition distribution was also similar (p-value: 0.694). For new cases, the time interval from appointment request till the actual encounter was very short for the virtual clinic group (range: 6-15 days) as compared to the in-person clinic group (range: 30-180 days). Patients were followed up for a median period of 14±3.25 months (range: 6-22 months) with no patient loss to follow-up. Conclusion Telemedicine can effectively bridge the patient-physician communication gap caused by the regulatory precautions mandated by the current COVID-19 pandemic. It achieved an attendance rate of 94% and parents’ / patients’ overall satisfaction of 92%.

Mixing technology with translation pedagogy is considered one of the recent methodologies in translation classrooms. The current research aimed to explore the effect of using an online collaborative translation technique based on Google Classroom on developing translation competence for English Majors and exploring their attitudes towards online collaboration. The study used the quasi-experimental pre-posttest. Two groups were randomly chosen amongst English Section Students at faculty of Education at Assiut University. The experimental group received training on translation through the suggested online collaborative translation technique while the control group received regular translation instruction. The experimental group students were engaged in collaborative translation tasks via Google Classroom three times a week for five weeks. Tools of the study included a pre-post translation test and a questionnaire to measure students’ attitudes towards online collaboration. Results of the study showed that using the suggested collaborative translation technique improved English majors’ translation competence. In addition, the results revealed that students developed positive attitudes towards online collaboration.

Background Breast cancer is the most common feminine malignant disease. Surgical treatment is the standard care for early stages, and breast conservation therapy became standard management for patients with small-sized tumors. Oncoplastic techniques aim to preserve this precious organ without distortion and with less morbidity. Applying the modified lateral intercostal artery perforator flap offers a one-stage, single position surgery with invisible scar, good access to the axilla and satisfying cosmetics. Methods This study was applied to 55 histo-pathologically-confirmed breast cancer patients. All patients were candidates for breast conserving surgery. Observations were recorded and data were collected. Results The procedure was overall very good, with smooth recovery after surgery and achieving both oncological safety and pleasant cosmetic results. The early post-operative complication were expected and easily dealt-with. No mortality was recorded. Modified lateral intercostal artery perforator flap offers a chance for patients with laterally located breast cancer and candidates for breast conservation. Conclusion In conclusion, our trial with modified LICAP was quiet satisfying. We recommend larger studies and longer periods of follow up.

Many attempts to control acute kidney injury (AKI) have failed due to a lack of understanding of its pathophysiological key components. Macrophages are a crucial determinant of AKI, which can be categorized functionally as M1 pro-inflammatory and M2 anti-inflammatory macrophages. Low-intensity pulsed ultrasound (LIPUS) is currently being investigated as an immune modulator. The present study aimed to explore the potential effects of LIPUS on the polarization of renal macrophages, as well as the possible interplay between macrophage polarization and necroptosis in gentamicin-induced acute kidney injury.All rats were randomly allocated into one of four groups: control, LIPUS-treated control, gentamicin acute kidney (GM-AKI), and LIPUS-treated GM-AKI. Renal functions, macrophage polarization, necroptosis, and heat shock protein-70 (HSP70) were analyzed using real-time reverse-transcriptase-polymerase chain reaction (rT-PCR), Western Blot, Enzyme-linked immunosorbent assay (ELISA) as well as immunohistological analysis.we found that LIPUS markedly inhibited the expressions of M1 macrophage-related genes and promoted significantly the expression of M2 macrophages related genes. This was accompanied by an inhibition of necroptosis and a marked reduction of HSP-70, resulting in a reversal of gentamicin-induced renal alteration.Functional switching of macrophage responses from M1 into M2 seems to be a potential approach to ameliorate necroptosis as well as HSP-70 by low pulsed ultrasound waves in GM-AKI.

Background: Pressure ulcers are the common conditions among patients hospitalized in acute and chronic care facilities and impose significant burden on patients, their relatives and caregivers. Pressure ulcers have been described as one of the most costly and physically debilitating complications since the 20th century. The pain and discomfort due to pressure ulcer prolongs illness, rehabilitation, time of discharge and even contribute to disability and death. Lengthy periods of immobilization are emotionally stressful for patients. Immobility related problems include pressure ulcers, pneumonia, constipation, loss of appetite, urinary stasis, urinary track infections and venous stasis or deep vein thrombosis. When the complications due to immobilization are prevented it helps an individual to be physically, emotionally and psychologically sound. These complications can be prevented through simple basic patient care like skincare, active-passive exercises, changing position and deep breathing exercises. Nurses have a key role in prevention of these complications by educating the patients. Hence the study was conducted “To evaluate the effectiveness of structured teaching programme regarding prevention of complications of immobilized patients . methods: The study involved 50 immobilized orthopaedic patients using the structured interview schedule. STP was implemented and post-test was conducted after 8 days using the same structured interview schedule to find out the effectiveness. Results: 86% of respondents were taking mixed diet and 60% had compound fracture. The main cause for the fracture was road traffic accident (46 %). Regarding effectiveness of Structure exercise plan , the overall mean percentage knowledge score in the pre-test was 34.71% and 80.91% in the post-test. The statistical paired ‘t’ test indicates that enhancement in the mean percentage knowledge score was found to be significant at P≤0.05 percent level for all the aspects . Conclusion: This study revealed that nursing staffs’ knowledge and practice about pressure ulcer preventive measures could be improved. Participants in the study reported that they could use the educational program effectively and easily in the prevention of pressure ulcers among their immobilized patients, which decreases the occurrence of pressure ulcers and as well as improved patient outcome. Keywords: pressure ulcer, post operative patients, structure exercise plan

Background: Enteric fever is a common infection found in many developing countries around the world, which often has life- threatening complications if not treated promptly. One of the rarest complications of enteric fever is splenic abscess. Case presentation: Our case is that of a 32-year-old male, admitted with febrile illness, diagnosed as typhoid fever (enteric fever) with rare complication- multiple splenic abscesses, after his travel to endemic area, which was effectively treated with antibiotics under inpatient setting. Conclusion: Early diagnosis with imaging modalities such as computed tomography can lead to better treatment approaches. Splenic abscesses are often treated with antibiotics or conservative treatment; however, non-responsive cases may require splenectomy.

Background: Autistic spectrum disorder (ASD) has a multifactorial etiology involving interactions between genes, environment, and diet. Among the environmental factors that have received significant attention related to ASD are toxic metals, such as lead (Pb). Given the importance of zinc (Zn) and copper (Cu) metabolism for healthy neurological functioning and detoxification of heavy metals. Selenium (Se) is an essential trace element having a very narrow range between deficient, essential, and toxic doses. Objective: To evaluate the association between the level of serum Cu, Zn, Pb, and Se in children with ASD. Patients and Methods: Our case-control study was carried out in the psychiatric and neurology clinic, Pediatric Department, Zagazig University Hospital, during the period 2018 - 2019. It enrolled 42 children, (13 males and 8 females) with autism diagnosed by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) and the Childhood Autism Rating Scales (CARS) (with no other medical disease). The control group enrolled 21 apparently healthy children. Results: There was a statistically significant difference between the studied groups regarding the presence of plasma zinc and selenium (lower in the autistic group). There was a statistically significant difference between the studied groups regarding the presence of copper and plasma lead (higher in the autistic group). There was a statistically significant negative correlation between plasma selenium and lead level. Conclusion: Our results suggested an association between serum Cu, Zn, Pb, and Se in children with ASD.

The present study was conducted to evaluate the effect of thymoquinone (TQ) on hepatocellular carcinoma (HCC) in rats. Our study has reported that TQ treatment of experimentally-induced HCC results in the up-regulation of the Jun-N-terminal kinase and p38 mitogen activated protein kinase pathway (JNK/p38 MAPK) and the enhancement of anti-inflammatory, anti-oxidant, and pro-apoptotic machineries. TQ resulted in a significant decrease in the levels of nuclear factor kappa-light-chain-enhancer of activated B-cells (NFκB), tumor necrosis factor-α (TNF-α), and a significant increase in the anti-inflammatory interleukin-10 (IL-10). The pro-apoptotic effect of TQ was demonstrated through stimulating the apoptotic Bcl-2-associated X (Bax) gene and inhibiting the anti-apoptotic B-cell lymphoma 2 (Bcl-2) gene together with increasing the level of caspase 3 and up-regulating the C/EBP homologous protein (CHOP-1) gene expression. TQ treatment also enhanced the activity of the ROS scavenger, superoxide dismutase (SOD), and decreased the level of the lipid peroxidation product malondialdehyde (MDA). TQ-dependent suppression of HCC was associated with the up-regulation of JNK/p38 MAPK, enhanced CHOP-1 expression, and subsequently increased Bax gene expression.

Synchronized uterine receptivity with the time of implantation is crucial for pregnancy continuity. Vitamin D (VD) deficiency has been linked to the failure of implantation. Therefore, we tested the link between the Homeobox transcription factor-10/immunophilin FK506-binding protein 52 (HOXA-10/FKBP52) axis and the uterine receptivity in VD-deficient rats. The effect of VD supplementation at different doses was also investigated. Forty-eight pregnant rats were divided into six groups (eight/group); normal control rats fed with standard chow (control), control rats supplemented with VD (equivalent dose of 400 IU/day) (control-D400). VD-deficient group (DEF) and the three VD deficiency groups with VD supplementation were equivalent to 400, 4,000, and 10,000 IU/day (DEF-D400, DEF-D4000, and DEF-D10000, respectively). The expression levels of HOXA-10/FKBP52, progesterone level, and histological evaluation of decidualization using osteopontin (OSN) and progesterone receptor (PGR) were estimated. An assessment of the uterine contractility was conducted for all rats. This study showed the downregulation of HOXA-10/FKBP52 together with increased amplitude and frequency of the uterine contractility in the DEF group compared to control. VD dose-dependent supplementation restored progesterone/receptor competency, upregulated the expressional response of HOXA-10 and its downstream FKBP52, and improved uterine receptivity and endometrial decidualization at the time of implantation that was documented by increased area% of OSN and the number of implantation beads.

Objectives: To detect the frequency of CD209 A>G polymorphism in sickle cell disease (SCD) Egyptian patients and to evaluate the use of CD209 A>G polymorphism as a genetic predictor of SCD clinical heterogeneity. Methods: A total of 100 Egyptian children with SCD and 100 Egyptian controls were tested for CD209 A>G polymorphism and were followed up prospectively between June 2012 and December 2014. Results: Comparison of CD209 A>G polymorphism among cases and controls did not show statistically significant difference (p = .742). In addition, comparison of the allelic frequency did not show statistically significant difference (p = .738). Infections occurred more frequently among the heterozygous genotype (AG; 60.5%) and homozygous genotype (GG; 75%) patients than among the wild (AA) genotype (24.1%; p G polymorphism. Infections occurred more frequently among the heterozygous genotype (AG) and homozygous genotype (GG) patients. Keywords: CD209 A>G polymorphism, Heterozygous genotype, Hydroxyurea, Homozygous genotype, Sickle cell disease

Background and study aim: Malnutrition is as an important complication of liver cirrhosis with prognostic implications; a marked knowledge gap exists concerning the information needs of liver cirrhosis patients. The aim of this study is to assess nutritional status and informational needs for patients with liver cirrhosis. Subjects and Methods: A descriptive exploratory design was used in this study. The present study conducted in tropical medicine and gastroenterology units at Zagazig University Hospitals, A purposive sample of 115 patients, The study lasted from the beginning of October 2016 to the end of May 2017 .Three tools were used for collection of data, first tool was a structured interview questionnaire consisted of personal characteristics of patients, second tool was nutritional assessment form, third tool was informational needs questionnaire. Results: The study findings revealed that more two third of studied patients were in the age group of less than Session [CurrentTestPartID] years with mean age 53.4±9.3 years, the majority of studied patients were in malnutrition (73.9%). By Subjective Global Assessment (SGA), there are strong correlation between SGA and Child Pugh score, the most important informational needs among the studied patients were medical domains 84.4%. In contrast, psychological domains achieved the least important 27.0%. Conclusion: It can be concluded that patients with liver cirrhosis are suffering from malnutrition and nutritional deficiencies, and also patient with liver cirrhosis had different levels of informational needs. The most prioritized informational needs for patients with liver cirrhosis was Medical domain whereas the least priority was given to the Psychological domain. It also shows that information needs differ based on some socio-demographic and clinical characteristics and physical condition.

To study the effect of intravenous injection of bone marrow mesenchymal stem cells (BMMSCs), alone and combined with NO inducer in gastric ulcer healing in a rat model.Rats were divided into controls, gastric ulcer, gastric ulcer receiving mesenchymal stem cells (MSCs), gastric ulcer receiving NO inducer (l-Arginine), gastric ulcer receiving MSCs plus NO inducer (l-Arginine) groups. MSCs were given in a dose of (10Injection of MSCs or NO inducer or both to the gastric ulcer group significantly decreased caspase-3 and BAX genes expression (apoptotic factors) and increased Bcl-2 gene expression (anti-apoptotic factor) compared to that of the gastric ulcer group after both 24h and 7days with more significant results in the gastric group received both MSCs and NO inducer. HGF gene expression was significantly increased in the groups injected with MSCs or NO inducer or both compared with the corresponding gastric ulcer group (p0.05, p0.05p0.001 respectively). There was a significant decrease in the mean PGE2 and TNF-α levels in the gastric ulcer group receiving MSCs, the gastric ulcer group receiving NO and the gastric ulcer group receiving both MSCs andNO compared to the gastric ulcer group after both 24h and 7days. Histopathological examination of gastric tissue of groups that received stem cells or NO alone, showed mucosal regenerative changes with increased thickness together with reduced inflammatory cellular infiltrate in the submucosa and decreased congestion. There was complete restoration in gastric mucosa in the group that received both stem cells and NO.Administration of MSCs, NO, or MSCs plus NO may exert a therapeutic effect on the mucosal lesion in gastric ulcer through their anti-inflammatory, angiogenic and antiapoptotic actions.

Hypertension(HTNorHT), also known ashigh blood pressure(HBP), is along-termmedical condition in which the blood pressure in the is persistently elevated.High blood pressure is a major risk factor forcoronary artery disease strokeheart failureatrial fibrillati on peripheral vascular disease vision loss chronic kidney disease dementia. Hypertension has a major economic impact ranging from medical costs to human capital loss and decrease in productivity.The Global Burden of Disease 2010 (GBD 2010) study shows the estimation that hypertension was the leading risk factor for death in the Kingdom of Saudi Arabia (KSA). Statistics shows that hypertension accounted for about 24% of total deaths from cardiovascular and circulatory diseases and 1.87% of total deaths from hypertensive urogenital, blood, and endocrine diseases. From 1990 to 2010 the burden of hypertension remained very high inKingdom of Saudi Arabia (KSA)Previous studies reported high levels of blood pressure in Kingdom of Saudi Arabia (KSA). These levels ranged from 26.1% among individuals 30–70 years old in 1995–2000 to 25.5% among individuals 15–64 years old in 2005,A study was done to assess Effectiveness Of Breathing Exercise In Lowering High Blood Pressure Among Hypertensive Patients At General Hospital ,Alnamas, Kingdom of Saudi Arabia.80 patientswere selected by convenient sampling method. Researcher’s convenience and familiarity with settings were added reason. The tool used for the study includes demographic data andvitalsignsassessmentsheet&digital BP apparatusto assess theblood pressure. After collecting the data, the data analysis was done according to the objectives of the study using descriptive statistics and inferential statistics. The study findings reveals that revealsthat, Level of significance (P-value < 0.001) assuggested by “Paired t test”. The mean pre-test totallevel of hypertensionScore beforebreathing exercisewas40and mean post-testlevel of hypertensionscore was observed to be 26.66. The reduction in hypertension over breathing exercise (Mean = 13.34,) was significantat 5%.So the breathing exercise was effective onhypertensive patient. The findings revealed that there was significant association betweenhypertensionlevelandage, gender,Education of the participant, Occupation of the participant, Duration since diagnosis ofhypertension, Family history of diabetes mellitus. But there is no association betweenhypertensionlevel and Religion, Marital status, Family income per –month. &nbsp

Background: Transforming growth factor-beta (TGF-β) signaling is recognized as being critical for carcinogenesis. Vitamin D has proved to exert numerous tumor suppressive effects. Effects of bone marrow derived mesenchymal stem cells (BM-MSCs) on tumor progression are still controversial. The present study was conducted to evaluate the effects of BM-MSCs and vitamin D on TGF-β signaling in an experimental hepatocellular carcinoma (HCC) model in rats. Materials and Methods: The study was conducted on fifty female white albino rats divided equally into 5 groups: controls, HCC induced by diethyl-nitrosamine (DENA) and carbon tetrachloride (CCl4), HCC plus MSCs, HCC plus vitamin D and HCC plus both MSCs and vitamin D. The following parameters were assessed in rat liver tissues: TGF-β and Smad2 protein levels by ELISA and western blotting, respectively, gene expression of Smad3, Smad7, Snail, HNF4α and MMP-2 and histopathological lesions. Serum levels of alpha fetoprotein (AFP), ALT and albumin were also assessed. Results: TGF-β protein levels and gene expression of its downstream effectors (Smad3 and Snail), in addition to Smad2 protein levels were significantly higher in the HCC group than in the control group. On the other hand, they were significantly down-regulated in all treated groups with most significant amelioration with both MSCs and vitamin D. Also, the serum levels of AFP were significantly increased in the untreated HCC group, and this was again reversed in all treated groups. Histopathological examination of liver tissue revealed that administration of MSCs or vitamin D into HCC rat group improved the histopathological picture with residual tumor pathology, while administration of both MSCs and vitamin D showed better restoration of liver parenchyma. These data suggest that the TGF-β signaling pathway could be used as a therapeutic target in HCC.

Our aim was to study the effect of platelet-rich plasma (PRP) on the proliferation of bone-marrow-derived mesenchymal stem cells (BM-MSCs) and to investigate their roles in the healing of experimental burn injury and the possible mechanism of action. Our work was divided into in-vitro and in-vivo studies. The in-vitro study included untreated MSCs and MSCs treated with PRP. Levels of TGF-β and cell proliferation were assessed. In the in-vivo study, 72 rats were distributed equally among 6 groups: control, burn, burn with MSCs, burn with PRP, burn with both MSCs and PRP, and burn with MSCs pretreated with PRP. On the 7th and 20th day after injury, the serum levels of transforming growth factor beta (TGF-β) and tumor necrosis factor alpha (TNF-α), as well as interleukin-10 (IL-10) levels in skin tissue were measured by ELISA; histopathology and gene expression of MMP-1, TIMP-2, Ang-1, Ang-2, and vimentin by real-time PCR were performed in all groups. In vitro: proliferation of MSCs and TGF-β increased in the PRP-treated group compared with the control group. In vivo: Ang-1, Ang-2, and vimentin were upregulated, whereas MMP-1 and TIMP-2 were downregulated. TGF-β and IL-10 were increased, whereas TNF-α was decreased in all treated groups with more significance in MSCs and PRP on day 20. Histopathology of burn skin was improved in all treated groups, particularly in MSCs pretreated with PRP 20 days post-burn.

Head injury (HI) is one of the major causes of disability, death and health related costs. The primary goal of nursing management in head injury is to maintain adequate cerebral tissue perfusion. This study aimed to evaluate the intensive care unit nurses’ performance regarding caring patients with head injury: Setting at Zagazig University Hospitals. Material and methods: a quasi-experimental (pre/post and follow up-test design) research design was utilized. A convenient sample of (45) nurses who provide direct care for head injury patients in neurological and stroke Intensive care Unit. Data was obtained using two main tools; head injury care knowledge assessment questionnaire with the socio-demographic data sheet, and head injury care practice observational checklists. The instructional intervention was designed based on an extensive revision of the related, recent literature. The intervention was delivered throughout ten weeks. Each week involved three sessions. Every session lasts about forty to sixty minutes. Nurses were divided into 9 groups, 5 nurses each. Results revealed that the mean knowledge and practice scores of nurses are increased immediately after implementation of the program with a significant statistical difference. This increased level slightly decreased following two months of program implementation. In addition, a positive correlation was found between knowledge and practice scores of the study subjects. Therefore, the two stated research hypothesis were supported. Conclusion educational intervention has a positive effect in developing critical care nursing performance regarding caring patient with head injury.

Postoperative breathing exercises are widely important for patient to prevent postoperative respiratory complications. Breathing exercises had a highly positive effect on improving quality of recovery among post-operative patients. This study aimed to assess the effect of breathing exercises on quality of recovery among post-operative patients. Setting at Zagazig University Hospitals. Material and Method: a quasi-experimental (pre and posttest design). A purposive sample of total 258 study participants, 129 in experimental and 129 in control group based on inclusion and exclusion criteria. Data collection questionnaire were prepared with extensive review of previous literatures. Data collection through three tools includes, interviewing questionnaire sheet, postoperative quality scale and visual analogue scale of patient postoperative quality assessment scale. Breathing exercise (BE) was taught and practiced by the patients in experimental group and in control group routine postoperative care was followed. Result: postoperative quality rate was significantly different in experimental group were higher than in control group. Conclusion: post-operative breathing exercises improve postoperative quality.

Background Curcumin exhibits anti-diabetic activities, induces heme-oxygenase-1 (HO-1) and is an inhibitor of transcriptional co-activator p300. A novel water soluble curcumin derivative (NCD) has been developed to overcome low invivo bioavailability of curcumin. We evaluated the effect of the NCD on signaling mechanisms involved in cardiomyocyte hypertrophy and studied whether its action is mediated via inducible HO-1. Materials and methods Rats were divided into controls, controls receiving NCD, diabetic, diabetic receiving NCD, diabetic receiving pure curcumin, diabetic receiving HO inhibitor, zinc protoporphyrin IX (ZnPP IX) and diabetic receiving NCD and ZnPP IX. NCD and curcumin were given orally. After 45 days, cardiac physiologic parameters, plasma glucose, insulin, glycated hemoglobin (GHb), HO-1 gene expression and HO activity in pancreas and cardiac tissues were assessed. Gene expression of p300, atrial natriuretic peptide (ANP) and myocyte enhancer factor 2 (MEF2A and MEF2C) were studied. Results NCD and curcumin decreased plasma glucose, GHb and increased insulin levels significantly in diabetic rats. This action may be partially mediated by induction of HO-1 gene. HO-1 gene expression and HO activity were significantly increased in diabetic heart and pancreas. Diabetes upregulated the expression of ANP, MEF2A, MEF2C and p300. NCD and curcumin prevented diabetes-induced upregulation of these parameters and improved left ventricular function. The effect of the NCD was better than the same dose of curcumin.