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BACKGROUND Over half of pregnant women experience anxiety symptoms, however perinatal mental health disparities exist. Women of Mexican descent exhibit higher levels of anxiety symptoms which may be linked to sociocultural stressors. However, little is known about culturally relevant factors that may protect against anxiety in this fast-growing population, such as religiosity, an important facet of Mexican culture. METHODS Pregnant women of Mexican descent (n = 197) were recruited from a local community clinic and followed into the postpartum period. Women completed surveys assessing religiosity, acculturation, acculturative stress, and anxiety symptoms. RESULTS Higher levels of religiosity were associated with lower levels of anxiety symptoms throughout pregnancy, but not postpartum (b = -1.01, p = .002). Additionally, religiosity significantly buffered the relationship between acculturative stress and anxiety symptoms during early (R2 = .13, b = -.12, p = .041), mid- (R2 = .19, b = -.19, p < .001) and late pregnancy (R2 = .14, b = -.13, p = .023), and at six weeks postpartum (R2 = .08, b = -.12, R2 = .08, p = .016). LIMITATIONS The study was limited to women of Mexican descent and it is possible that other immigrant groups may exhibit different patterns of religiosity and anxiety symptoms. CONCLUSIONS These results suggest that religiosity may be protective against maternal anxiety among women of Mexican descent, which has important implications for culturally relevant perinatal interventions and treatments.

Objectives: Current diagnostic tests for tuberculosis (TB) in children living in low-endemic countries are limited by low specificity and the inability of the current tests to differentiate between active TB and latent TB infection (LTBI). This study aimed to evaluate the blood IP-10 mRNA expression level to detect LTBI in Egyptian pediatric household contacts (PHC). Methods: TB-specific IP-10 and IFN-γ mRNA levels were assessed by real-time quantitative PCR (RT-qPCR) in 72 Egyptian PHC of active pulmonary TB cases. All study participants were also assessed by Tuberculin Skin Test (TST) and Quantiferon gold in tube (QFN-GIT) assay. Results: IP-10 and IFN-γ mRNA expression levels were significantly higher in PHC with active TB or LTBI than TB negative (p < 0.0001). The level of IP-10 mRNA expression was significantly higher in PHC with active TB than LTBI (p = 0.0008). In contrast, there was no significant differences in the IFN-γ mRNA expression between PHC with active TB compared to LTBI (p = 0.49). The sensitivity and specificity of the IP-10 RT-qPCR were 94.2% and 95.2%, respectively, in PHC with active TB compared to 85.7% and 81.8% in PHC with LTBI. The negative and positive predictive values and accuracy of IP-10 RT-qPCR for distinguishing active TB from LTBI were 85.2%, 58.3%, and 72.6% respectively. Conclusion: Blood IP-10 mRNA expression level may be a potential diagnostic marker to help distinguish active TB from LTBI in PHC.

This study aimed to compare the change in levels of several laboratory values and the development of adverse events using two commonly used intramuscular testosterone therapy regimens. Men were included if they were 18 years or older and received one of the following testosterone therapy regimens: 100 mg intramuscular once weekly or 200 mg intramuscular once every other week. Primary outcomes were relative changes in total testosterone, free testosterone, estradiol, prostate-specific antigen, and hematocrit at 6 months after initiation of testosterone therapy. Secondary outcomes were any significant rises in estradiol, hematocrit, prostate-specific antigen, and any other treatment-related adverse events requiring cessation of testosterone therapy. A total of 263 men were enrolled. In a subanalysis of men who had a baseline hematocrit below 54% before intramuscular testosterone therapy initiation, we found the following: men who received 100 mg weekly injections were significantly less likely to have hematocrit levels rising above 54% (1/102 (1%) vs. 4/51 (8%); p = 0.023). No significant differences were recorded in the increase in total testosterone, free testosterone, prostate-specific antigen, and estradiol levels between both groups. A higher average serum testosterone over the dosing interval seen with the 200 mg regimen appears to be associated with a higher risk of erythrocytosis.

BACKGROUND: Persistent respiratory symptoms and lung function deficits are common after patients with TB. We aimed to define the burden of post-TB lung disease (PTLD) and assess associations between symptoms and impairment in two high TB incidence communities.METHODS: This was a cross-sectional survey of adults in Cape Town, South Africa who completed TB treatment 1–5 years previously. Questionnaires, spirometry and 6-minute walking distance (6MWD) were used to assess relationships between outcome measures and associated factors.RESULTS: Of the 145 participants recruited (mean age: 42 years, range: 18–75; 55 [38%] women), 55 (38%) had airflow obstruction and 84 (58%) had low forced vital capacity (FVC); the mean 6MWD was 463 m (range: 240–723). Respiratory symptoms were common: chronic cough (n = 27, 19%), wheeze (n = 61, 42%) and dyspnoea (modified MRC dyspnoea score 3 or 4: n = 36, 25%). There was poor correlation between FVC or obstruction and 6MWD. Only low body mass index showed consistent association with outcomes on multivariable analyses. Only 19 (13%) participants had a diagnosis of respiratory disease, and 16 (11%) currently received inhalers.CONCLUSION: There was substantial burden of symptoms and physiological impairment in this “cured” population, but poor correlation between objective outcome measures, highlighting deficits in our understanding of PTLD.

Background: Leukemia is the most common malignant tumor in children, responsible for nearly one-third of all childhood cancers. However, the exact risk factors of childhood leukemia are unknown. Objective(s): The aim of this study was to identify risk factors of leukemia among Upper Egyptian children. Methods: We conducted a case-control study in 2019. Cases included 170 children aged ≤18 years with a confirmed leukemia diagnosis at the South Egypt Cancer Institute. The controls included 170 children matched for age and sex, free from hematological problems, and diagnosed with a mild illness in a pediatric outpatient clinic. Data were collected from children’s parents using an interview questionnaire. Results: The significant predictors for childhood leukemia were abnormal birth weight (4 kg) (OR = 2.89, 95% CI: 1.46–5.71) and childhood exposure to previous diagnostic radiation (OR = 3.95, 95% CI: 1.37–11.31). The risk increased if the father’s occupation was farming (OR = 2.14, 95% CI: 1.04–4.40), household monthly income Conclusion: Abnormal birth weight, father’s occupation is farming, exposure to diagnostic radiation and pesticides, family history of leukemia or other cancers, and low income are risk factors for leukemia in Egyptian children.

Background Childhood interstitial and diffuse lung diseases (chILD) encompass a broad spectrum of rare pulmonary disorders. In most developing Middle Eastern countries, chILD is still underdiagnosed. Our objective was to describe and investigate patients diagnosed with chILD in a tertiary university hospital in Egypt. Methods We analysed data of consecutive subjects (aged, In Egypt, childhood interstitial and diffuse lung diseases (chILD) are still underdiagnosed. Establishment of an Egyptian chILD network with genetic testing is essential to improve healthcare for children diagnosed with chILD. https://bit.ly/385qKsU

Autism Spectrum Disorder (ASD) and learning disabilities are neurodevelopmental disabilities characterized by dramatically increasing incidence rates, yet the exact etiology for these disabilities is not identified. Impairment in tryptophan metabolism has been suggested to participate in the pathogenesis of ASD, however, further validation of its involvement is required. Additionally, its role in learning disabilities is still uninvestigated. Our objective was to evaluate some aspects of tryptophan metabolism in ASD children (N = 45) compared to children with learning disabilities (N = 44) and healthy controls (N = 40) by measuring the expression levels of the MAOA, HAAO and AADAT genes using real-time RT-qPCR. We also aimed to correlate the expression patterns of these genes with parental ages at the time of childbirth, levels of serum iron, and vitamin D3 and zinc/copper ratio, as possible risk factors for ASD. Results demonstrated a significant decrease in the expression of the selected genes within ASD children (p p p MAOA, HAAO and AADAT genes may underpin the pathophysiology of ASD.

Objective To evaluate the efficacy of carbetocin versus placebo in decreasing intraoperative blood loss and the need for blood transfusion during abdominal myomectomy. Design Randomized, double-blind, placebo-controlled trial. Setting Tertiary university hospital from September 2019 to February 2020. Patient(s) A total of 138 women with symptomatic leiomyoma who were candidates for abdominal myomectomy (n = 69 in each group). Intervention(s) We randomized the study participants in a 1:1 ratio to carbetocin and placebo groups. Intravenous 100 μg carbetocin or placebo was administered slowly after induction of anesthesia. Main Outcome Measure(s) Intraoperative blood loss, need for blood transfusion, postoperative hemoglobin, operative time, length of hospitalization, and drug side-effects. Result(s) The baseline characteristics were similar among all groups. Carbetocin had significantly lower intraoperative blood loss compared with placebo (mean difference 184 mL). Hemoglobin level 24 hours after surgery was significantly lower in the placebo group than in the carbetocin group (9.1 ± 0.8 vs. 10.3 ± 0.6 g/dL). Eight women in the carbetocin group needed blood transfusion compared with 17 in placebo group. Operative time, length of hospitalization, and side-effects were similar in both groups. Conclusion(s) A single preoperative intravenous dose of 100 μg carbetocin is a simple, practical, and effective method of decreasing intraoperative blood loss and the need for blood transfusion during abdominal myomectomy, with tolerable, few, nonsignificant side-effects. Clinical Trial Registration Number NCT04083625

BackgroundCurrent incidence and outcome of patients with acute hypoxaemic respiratory failure requiring mechanical ventilation in the intensive care unit (ICU) are unknown, especially for patients not meeting criteria for acute respiratory distress syndrome (ARDS).MethodsAn international, multicentre, prospective cohort study of patients presenting with hypoxaemia early in the course of mechanical ventilation, conducted during four consecutive weeks in the winter of 2014 in 459 ICUs from 50 countries (LUNG SAFE). Patients were enrolled with arterial oxygen tension/inspiratory oxygen fraction ratio ≤300 mmHg, new pulmonary infiltrates and need for mechanical ventilation with a positive end-expiratory pressure of ≥5 cmH2O. ICU prevalence, causes of hypoxaemia, hospital survival and factors associated with hospital mortality were measured. Patients with unilateral versus bilateral opacities were compared.Findings12 906 critically ill patients received mechanical ventilation and 34.9% with hypoxaemia and new infiltrates were enrolled, separated into ARDS (69.0%), unilateral infiltrate (22.7%) and congestive heart failure (CHF; 8.2%). The global hospital mortality was 38.6%. CHF patients had a mortality comparable to ARDS (44.1% versus 40.4%). Patients with unilateral-infiltrate had lower unadjusted mortality, but similar adjusted mortality compared to those with ARDS. The number of quadrants on chest imaging was associated with an increased risk of death. There was no difference in mortality comparing patients with unilateral-infiltrate and ARDS with only two quadrants involved.InterpretationMore than one-third of patients receiving mechanical ventilation have hypoxaemia and new infiltrates with a hospital mortality of 38.6%. Survival is dependent on the degree of pulmonary involvement whether or not ARDS criteria are reached.

Background The corneal cross-linking procedure has been proven to be an effective method to treat and stabilize keratoconus progression, but early vision rehabilitation is still needed in patients. Aim The aim was to compare the results of the combined CXL and intrastromal corneal ring segment implantation procedure to that of the cross-linking-alone procedure in terms of visual acuity, refraction, and some corneal topographic parameters in keratoconic patients. Design This was a prospective, comparative, and interventional study. Patients and methods This study was carried out on 44 keratoconic patients (60 eyes) of both sexes who ranged from 18 to 36 years. Thirty eyes were subjected to the CXL-alone procedure and 30 eyes were subjected to the combined procedure. Measurements were performed in all patients preoperatively and at 3, 6 months, and 1 year postoperatively including unaided visual acuity, best-corrected visual acuity, refractive, and topographic outcomes. Results Through the entire study period, both procedures were safe and effective in treating and stabilizing keratoconus progression. Furthermore, the combined group showed additional improvements over the CXL group for the following: UDVA at 3 months (P=0.0028), best-corrected visual acuity at 1 year (P=0.011), refractive and keratometric astigmatism at all follow-up visits and corneal asphericity at 3 months (P=0.013) and 6 months (P=0.0221) of follow-up. No severe intraoperative or postoperative complications were observed during the entire study period in either group. Conclusions The combined procedure is safe and effective for earlier improvement of visual and refractive outcomes in addition to the corneal stabilizing effect.

Background Acute bilateral lower limb weakness is a common problem in children which necessitates a rapid method for diagnosis. MRI is a non-invasive imaging technique that produces high-quality images of the internal structure of the brain and spinal cord. Results MRI was very helpful in reaching rapid and prompt diagnosis in children with acute inability to walk. Acute disseminated encephalomyelitis (ADEM), Guillain–Barré syndrome (GBS), and acute transverse myelitis (ATM) were the most common causes in our study. MRI proved to be of high sensitivity in detecting the lesions and reaching the diagnosis in ADEM and GBS; however, there was no significant relation between the lesions’ size, enhancement pattern, and severity of the disease or prognosis, yet in ATM the site of the lesion and number of cord segment affection were significantly related to the severity of the disease and prognosis. Conclusion MRI is a quick tool to reach the diagnosis of children with acute secondary inability to walk, and to eliminate other differential diagnosis which is essential for proper treatment and rapid full recovery. It is highly sensitive in detecting the lesions, their site and size.

In today's competitive business environment, business entities are faced with greater uncertainties (threats and opportunities) as they strive to create value. In the quake of the current global economic crisis, businesses in a bid to stay competitive have taken several crucial measures. However, for companies to keep track of their strategies, achieve their strategic objectives and reduce the impact of uncertainties, appropriate decisions should be made with a solution that reduces the impact of risks. Technical reports from companies showed that there is deviation from their original strategic plan tracks, and they are unable to achieve their strategic objectives. A preliminary study was conducted to identify the factors that lead to inefficiencies during strategic plan implementation. The result of the preliminary study showed that there is lack of risk management, especially information and incentive alignment risks. This research aims to propose a framework that mitigates risks during strategy implementation, through how the key choices made in strategy will either increase or reduce two characteristic types of risk (information and incentive alignment risks). These two types of risk (which are not mentioned in depth in other or past types of risk management categories) are the key inefficiency creators in the strategic planning and decision making that arise because of decision patterns. The proposed framework considers how to question the key decisions and how to turn inefficiencies into opportunities and points of power to create value. The proposed framework also presents essential fundamental concepts and enablers for achieving sustainable performance such as developing organizational capability, creative thinking, innovation, agility, succeeding through people and sustained outstanding results. The framework presents a mechanism to identify and assess the information and incentive alignment risks in the key decisions. The developed framework helps to reinvent desired strategic performance which lies in changing how decisions are made., {"references":["Karin Zach Mann. History of Technology. Munich Center for Technology in Society. Technische University, München, Deutsches Museum. 80306 Munich, Germany, 2014","C. Crouhy. The essentials of risk management. Second edition. US, 2014","Alexander Roberts. Dr William Wallace. Mr Neil McClure. Strategic Risk Management- Edinburgh Business School Heriot. Watt University Edinburgh. EH14 4AS. United Kingdom. 2012","Joanne Curtis Taylor. Concepts of strategic risk and managing strategic risk. Janury 2012","Playbook: Enterprise Risk Management for the U.S. Federal Government, 2016","Ghosh. Strategic Planning: A Contingency Approach, vol. 16, no. 4, pp. 93–103, AYC, 2.13","Drucker. The Practice of Management. H& R, New York, P 2001","Galloway. Strategic management in public sector research organizations: a critical review, International Journal of Public Sector Management, vol. 3, no. 1, pp. 5–24, ID 2000","Wheelen and Hunger. Strategic Management. Addison-Wesley. Reading, Mass. JD 2015","Hambrick. Environmental Scanning and Organizational Strategy, Strategic Management Journal, vol. 3, no. 2, pp. 159–174, 2011","Barringer and Bluedorn, The Relationship Between Corporate Entrepreneurship and Strategic Management, Strategic Management Journal, vol. 20, pp. 421–444, 1999","Bluedorn. The interface and convergence of the strategic management and organizational environment domains, Journal of Management, vol. 20, pp. 201–262, 2012","Clark, Strategic management tools usage: a comparative study Strategic Change, vol. 6, pp. 417–427. 2007","Maria Stoyanova Todorova. Management Information Systems: Information As A Strategic Resource Impact On Company's Strategy. 3 Nov 2017","Christopher M. Scherpereel, Alignment: the duality of decision problems, Northern Arizona University, College of Business Administration, Flagstaff, Arizona, USA, 2006","Karan Girottra And Serguel Netessine. The Risk Driven. Harvard Business Review Press. Boston. 2014","Suzanne McGilloway. Introduction of a performance management and development system, National College of Ireland. July 2005","The EFQM Excellence Model 2013, EFQM. Organization. Brussels, Belgium; 2013","Sam Redding and Allison Layland. Strategic Performance Management, Building State Capacity and Productivity Center. 2015"]}

Background & Objective(s): Hairdressers are exposed to various health hazards in their work environment. This study aims to assess the working conditions, knowledge, and practices regarding hazardous work exposure, in addition to identifying potential occupational health problems and their associations. Methods: A cross-sectional study including 151 female hairdressers was conducted in Assiut city, Upper Egypt. An interview questionnaire was used to record personal and job characteristics, descriptions of workplace environments, and knowledge and practices regarding occupational health risks and self-reported health problems. Standard assessment of weight and height was performed, and body mass index was calculated. Results: Insufficient ventilation of salons was reported by 67.5% of the hairdressers, and first aid measures were available for only 15.2%. Low awareness was found regarding blood-borne diseases transmitted through hair salons. Approximately 70% were disinfecting their equipment, and 12.4% performed this after each customer. The most frequent chronic musculoskeletal complaints were lower back (22.5%), shoulder (17.2%), and wrist pain (16.6%). Nearly 24% complained from varicose veins. Varicose veins and knee pain were significantly associated with increases in age and working years. Neck pain was significantly associated with increases in age and not being employed by an owner or shared owner of the hairdressing salon. Conclusion: Proper working conditions and safe practices of the studied hairdressers were insufficient. High awareness was found regarding the possibility of disease transmission through hair salons. However, only a few of them identified these diseases and their transmission modes. Moreover, they complained about musculoskeletal pain, varicose veins, and respiratory symptoms. Recommendations: Pre-employment health education programs should be provided for Egyptian hairdressers, and maintenance of hairdressing salons should be checked regularly.

Mahmoud Alalfy,1 Omneya M Osman,2 Sameh Salama,1 Yossra Lasheen,2 Mahmoud Soliman,2 Mohamed Fikry,2 Mohamed Ramadan,2 Doaaa Alaa,2 Shaimaa Elshemy,2 Rana Abdella2 1Reproductive Health and Family Planning Department, National Research Centre, Dokki, Cairo, Egypt; 2Obstetrics and Gynecology Department, Kasr Alainy, Faculty of Medicine, Cairo University, Egypt, Algezeera Hospital, EgyptCorrespondence: Mahmoud AlalfyReproductive Health and Family Planning Department, National Research Centre, P.O: 12622, Affiliation ID: 60014618, Dokki, Cairo, EgyptTel +20 1002611058Email mahmoudalalfy@ymail.comBackground: Many expressions were used to define the defect that is seen by ultrasound after cesarean section (CS) namely scar defect, niche, isthmocele, uterine pouch or diverticula.Objective: To compare the accuracy of 2 dimensional sonohysterography (2D SHG) to 3 dimensional sonohysterography (3D SHG) in evaluating cesarean section uterine scar depth (D), base width (BW), width (W) and residual myometrial thickness (RMT) in women with secondary infertility and establishment of a standard criteria; Alalfy simple rules for scar assessment.Patients and Methods: This was an observational cross-sectional comparative study that was conducted on women who presented with secondary infertility and were candidates for intracytoplasmic sperm injection (ICSI) and giving a history of a previous cesarean section. Assessment of uterine scar in each woman was performed using 2D transvaginal ultrasound with sonohysterography (SHG) followed by 3D transvaginal with SHG with evaluation of niche depth, width, RMT, niche BW and RMT/depth ratio. The study was conducted at Algezeera hospital, Egypt.Results: The present study revealed that 3D ultrasound with SHG is superior in evaluation of the RMT and niche width prior to ICSI providing better characterization of the scar niche.Conclusion: Scar niche should be assessed by a combined integrated 2D SHG and 3D SHG scan with the specific geometrical and anatomical considerations, Alalfy simple rules for scar niche assessment that involvemeasurement of niche depth, (Base width) BW, width, RMT and RMT/depth ratio in sagittal plane, RMT in coronal plane / niche width in coronal plane ratio (ratio less than 1 denotes scar weakness with more liability for dehiscence).Trial Registration: Clinical Trials.gov Id NCT04076904.Keywords: cesarean, niche, two dimensional, 2D, three-dimensional, 3D, sonohysterography, SHG

Purpose Mammography screening (MS) is an underutilized screening tool; although it is provided free of charge to the Saudi community. The present study aimed at assessing knowledge and barriers of mammography screening among women attending primary health centers in Aljouf region, Saudi Arabia. Materials and methods A cross-sectional study was carried out among 423 women aged 41-75 years attending ten primary health centers in Aljouf region, Saudi Arabia. Structured interviewing questionnaires were used for data collection. SPSS program, version 24 was used for data analysis. Results The least reported risk factors of BC in this study were early menarche (14.9%), first pregnancy after the age of 30 years (18%), and late menopause (18.7%). Concerning knowledge of MS, 50.8% of the women correctly identified that mammogram is the ideal method for detecting BC. The most encountered personal barriers towards MS were lack of information about mammogram (69.5%), fear of exposure to radiation (67.4%), fear of discovery of BC (62.9%), being busy all the time (62.2%), and fear of cancer treatment (61.9%). Regarding economic barriers, 40% of the participants reported that taking sick leave from work is difficult while 37.8% revealed that mammogram is costly. Concerning health system barriers, the most common barriers were fear of error in diagnosis (62.6%), long time to take medical appointment (57%), and preferring not to have a mammogram except after a doctor recommendation (52.7%). The present study showed that women's education and residence significantly predicted their knowledge. Furthermore, women's education and income significantly predicted their barriers towards MS. Conclusion Many barriers toward mammography screening were encountered in the present study. Addressing these barriers and raising awareness about MS may be of great value to increase its uptake by Saudi women.

BACKGROUND AND OBJECTIVE Lower Urinary Tract Symptoms (LUTS) and Benign Prostatic Hyperplasia (BPH) are progressive ailments resulting from androgenic imbalances and aging that can lead to serious long term complications. Objective of this study was to determine the relationship between prostate-specific antigens and testosterone hormone levels in patients with BPH before transurethral surgery. MATERIALS AND METHODS This case control study was done on 112 serum samples collected from two secondary care centres in Khartoum, Sudan. Collected serum samples were analyzed by ELISA and fluorescence enzymes immunoassay to measure testosterone, total PSA level and free PSA levels, respectively. RESULTS Out of 112 patients, 56 BPH diagnosed patients were included in the study with mean age 67.10±7.90 years. Total PSA (T. PSA) levels were higher in patients (14.1±10.6 ng mL-1) than the control group (2.21±1.01 ng mL-1). Total 52% of patients had total PSA level in the gray zone (4-10 ng mL-1) and 33% had total PSA more than 10 ng mL-1. Testosterone levels were low in patients 3.97±2.84 ng mL-1 when compared to the control group 4.95±0.59 ng mL-1. CONCLUSION The present study revealed that, there was a strong association between T. PSA level and testosterone hormone in BPH patients, which suggested that monitoring of testosterone level is useful in patients with prostate enlargement.

The purpose of this study is to test the capability of a commercially available feature tracking-cardiac magnetic resonance (FT-CMR) strain analysis software module in differentiating between viable and non-viable myocardium in chronic ischemic patients. Thirty chronic ischemic patients and 10 healthy volunteers were enrolled. Cine images were used for peak circumferential and radial strains quantification using dedicated FT-CMR software. Global strain was compared between patients and controls. In patients, segmental strain was compared in viable and non-viable myocardium determined by late gadolinium enhancement (LGE); and in segments with wall abnormalities. Among 480 myocardial segments analyzed in patients, 76 segments were non-viable on LGE. The mean left ventricular ejection fraction (LVEF) of the patients (87% males, mean age 55 ± 12 years) was 40 ± 12% vs. 61 ± 5% for the controls (80% males, mean age 39 ± 11 years). Peak global circumferential strain (GCS) and global radial strain (GRS) were significantly impaired in patients compared to controls (−13.89 ± 4.12% vs. −19.84 ± 1.47%), p

OBJECTIVE To evaluate the efficacy and safety of collagenase Clostridium histolyticum (CCH) for the management of penile deformities in patients presenting with different categories of atypical Peyronie's disease (PD). METHODS We conducted a retrospective review of charts of patients who presented to a men's health clinic with atypical PD between October 2016 and June 2019. We included patients in the stable phase of the disease, had completed a penile duplex Doppler ultrasound before any intervention, and proceeded with CCH treatment. Gathered data included patient demographics, treatment details, outcomes, and complications. Outcomes collected were both quantitative (curvature assessments) and qualitative using the symptom bother domain (last 6 questions; Q10 to Q15) of the Peyronie's Disease Questionnaire. RESULTS Twenty-one men with stable PD underwent CCH inject therapy after penile duplex Doppler ultrasound. The mean number of injections was 8.4 (standard deviation [SD] = 3.3), and the mean follow-up was 20.5 months (SD = 5.9). The overall mean change in penile curvature was −19.2° ± 8.3°, which corresponded to a −39% ± 13% improvement in curvature (P = .0079). In men who presented with an indentation or hourglass deformity, 11 of 17 (64%) were satisfied and reported subjective improvement in narrowing/indentation after receiving CCH injections. The average composite symptom bother domain of the Peyronie's Disease Questionnaire decreased by 6.7 (P = .0029). CONCLUSION Our results suggest that CCH appears to be safe and provide significant clinical improvements in men presenting with atypical PD.

Purpose: to investigate the effect of walking on physiological stress in premenstrual syndrome (PMS). Methods: Thirty females with PMS were randomly distributed into two equal groups. Group (A) (n=15) received breathing exercises, while group (B) (n=15) received the same breathing exercises in addition to walking on a treadmill. The primary outcomes were serum cortisol levels, resting heart rate (HR) and resting respiratory rate (RR) to measure the level of physiological stress, while the secondary outcomes were daily record of severity of problems (DRSP) and abdominal pain assessed by visual analogue scale (VAS). The outcome measures were evaluated pre-treatment and after 8 weeks of treatment. Results: Comparing both groups post-treatment revealed non-significant differences in serum cortisol levels, resting HR and DRSP (P>0.05), while there were significant reductions in both resting RR and abdominal pain VAS (P

Background Modern-day penile prostheses use infection retardant coating to decrease rates of postoperative infection, subsequently reducing explantation and revision rates as well. The Coloplast Titan models are dipped into antimicrobial solutions right before implantation, and the components used for dipping can be tailored toward the patient. Aim To compare infection, explantation, and revision rates among different dipping solutions used before implantation for patients with diabetes receiving a Coloplast Titan implant. Methods We systematically reviewed 932 patients with diabetes receiving a primary penile implant across 18 different centers from the period April 2003 to August 2018. Of those patients, 473 received a Coloplast device, whereas 459 received an AMS device. Data regarding the type of antimicrobial solution used before implantation were recorded for 468 patients receiving a Coloplast Titan, including whether or not they suffered a postoperative infection and if they underwent explantation and/or revision. Outcome rates were compared using Fisher’s exact and Pearson’s chi-square tests, and logistic regression modeling was performed to account for covariates. Outcomes The main outcome measures of this study were postoperative infection, explantation, and revision rates. Results Of the total 932 patients reviewed, 33 suffered a postoperative infection. Of 468 patients receiving Coloplast implants, there was a 3.4% infection rate. The most commonly used antibiotic combination before dipping was vancomycin + gentamicin (59.0%). There was a significantly lower rate of postoperative infection, explantation, and revision when vancomycin + gentamicin was used than those associated with the use of all other dipping solutions ([1.4% vs 6.4%; P = .004], [1.1% vs 8.3%; P < .001], and [2.5% vs 12.5; P < .001], respectively). After adjusting for age, body mass index, preoperative blood glucose level, and hemoglobin A1c, the use of other dips was an independent predictor of postoperative infection (odds ratio: 0.191; P = .049). The inclusion of rifampin in the dipping solution trended toward being a significant risk factor for infection (P = .057). Including antifungals in the dipping solution did not affect infection (P = .414), explantation (P = .421), or revision (P = .328) rates. Clinical Implications Vancomycin + gentamicin was the most efficacious combination of antibiotics used for dipping in terms of preventing postoperative infection and subsequent explantation and revision. Strengths and Limitations Data were sampled across multiple institutions providing a large sample that may be more representative of the population of interest. A key limitation of the study was its retrospective nature, which prevented us from controlling certain variables. Conclusion The use of rifampin did not provide the same type of protection, possibly representing a shift in resistance patterns of common bacteria responsible for device infection.

Background Testicular ectopia is defined as a testis which is located away from the normal pathway of testicular descent and outside its ipsilateral hemiscrotum. Controversies have been raised about considering the abdominal and inguinal ectopic testes as undescended ones. Our purpose was to review our center’s experience with the diagnosis and management of testicular ectopia focusing on the inguinal ectopic testis. Retrospectively, we studied the clinical and surgical characteristics of a case series of testicular ectopia which was managed in our center during July 2001–June 2016. Results Out of 1132 patients with undescended testes, 44 cases (3.9%) had testicular ectopia. Twenty-three cases (mean age = 5.15 ± 5.79 years) fulfilled the criteria of inguinal ectopic testis. Clinically, testes were relatively mobile and superficial. Surgically, they were located in the superficial inguinal pouch, had relatively long spermatic cords, and commonly had average rather than small sizes. The other ectopic 21 cases (mean age = 10.56 ± 6.92 years) were perineal, anterior abdominal wall, femoral, prepubic, and transverse testes in 7 (33.3%), 4 (19%), 4 (19%), 3 (14.3%), and 3 (14.3%) cases, respectively. Congenital inguinal hernia was the commonest associated anomaly (22.7%). All cases were treated surgically with only 1 case of testicular atrophy (2.3%). Conclusions Testicular ectopia is rare with relatively delayed presentations. Different anatomical sites have been reported including the superficial inguinal pouch and anterior abdominal wall with variable complexities and controversies. The inguinal ectopic testis is the most controversial, but it might be characterized from other entities based on certain clinical and surgical criteria.

The present study is a part of a monitoring program of the most important living natural resources, investigating the substrate cover distribution in the most northern islands of the Egyptian Red Sea. These resources include both hard and soft corals. This study was made during winter 2017 using Line Intercept Transact (LIT) to monitor the diversity and distribution of those resources. Eight islands located at the entrance of the Suez Gulf were surveyed using standard methods. Monitoring work for the hard and soft corals using transect was done by diving and snorkeling in the study areas. In the current study, the highest percentage cover of hard corals was 84 % recorded at Ghanim Island compared with the lowest cover of 41.3 %, estimated at Ashrafi Island, with mean percentage cover for all Islands averaged 60.1%. Acropora and Stylophora were the most abundant hard coral genera with a percentage cover of 35.8% and 17.6 %, respectively. Soft corals were the highest at Tawila Island with a percentage cover of 6% and the Nephthea was the highest soft coral genera with a percentage cove of 1.0 %. The monitoring work showed the diversity and distribution of these natural resources, especially coral reefs, and the extent to which these resources are affected by human activities, especially tourism activities, and also extraction and drilling for oil near the study areas. Observations on hard and soft corals in the study areas may be useful and important in the development of those areas in the future.

A variety of pharmacological and non-pharmacological interventions have been investigated, with the goal of relieving pain after post-episiotomy repair. We aimed to compare the efficacy of tramadol versus celecoxib orally in reducing pain after mediolateral episiotomy repair in obese primigravidae undergoing spontaneous vaginal delivery. We conducted a randomized double-blinded trial in Cairo University hospital, Cairo, Egypt, from October 2018 to December 2019. We randomly assigned 200 women into two groups: group A (n = 100) received one tramadol tablet 100 mg orally whereas group B (n = 100) received one celecoxib tablet 200 mg orally. Our primary outcome was pain score using a 10-cm visual analog scale at different time intervals. Our secondary outcomes were the overall satisfaction score and drug side effects. After mediolateral episiotomy repair, the pain scores at 1, 2, and 4 h were significantly lower in the tramadol group than in the celecoxib group (p

Highlights • The second common presentation of extra pulmonary tuberculosis is urogenital tuberculosis. • Most patients present with general symptoms, rarely they present like RCC. • Suspicion of Tb is crucial to avoid missing UGTB for RCC particularly in epidemic countries. • Renal cell carcinoma and genitourinary tuberculosis can coexist., Introduction Renal tuberculosis (RTB) has no specific presentation and symptoms can be absent in up to 8% of cases in developing countries. Most patients present with symptoms like fever, burning micturition, pyuria, weight loss, and loin pain. In very rare occasions RTB can present as a renal mass mimicking renal cell carcinoma RCC. Case report We report a case that was initially diagnosed as renal cell carcinoma and histopathology revealed renal tuberculosis. Discussion Tuberculosis is more common than renal cell carcinoma, the WHO states that 1 in every three individuals have TB worldwide, but something to keep in mind is that the incidence of RCC is increasing by the rate of 1% since the year 2006. Hence uncommon presentations of common diseases are more common than common presentations of uncommon diseases, then when doctors encounter a patient who is presenting with renal mass especially in countries that are endemic with TB a probability of uncommon presentation of UGTB should be considered to avoid missing the chance of treating a medically curable condition. Most of the reported cases in the literature about pseudo tumor presentation of UGTB indicate that most of the cases presented with unilateral mass mimicking RCC and TB is detected after radical nephrectomy. Conclusion RTB can mimics RCC clinically and radiologically, which creates a diagnostic challenge. The chance of diagnosing renal TB in a patient presenting with renal mass is extremely lower than the chance of missing it for RCC, this because of the lack of evidence-based diagnostic approaches.

Background: MicroRNAs (miRs) are noncoding gene regulators that may have a role as diagnostic or prognostic biomarkers in systemic lupus erythematosus (SLE) and its complications. SLE is an autoimmune disease that may be associated with secondary antiphospholipid syndrome (APS). Aim of the work: To evaluate the plasma levels of both miR-146a and miR-126 as well as serum alpha interferon (α IFN) in Egyptian SLE patients with and without secondary APS and to investigate their potential role in disease pathogenesis and their utility as biomarkers for APS. Patients and methods: 88 SLE patients including 30 cases with secondary APS and 40 matched healthy individuals were enrolled in this study. SLE disease activity index (SLEDAI) was assessed. The plasma levels of miR-146a and miR-126 were determined by Realtime polymerase chain reaction (PCR) in all participants. Results: The mean age of the patients was 31.3 ± 9.6 years with disease duration 1–17 years. Plasma miR-146a was significantly lower and miR-126 significantly higher in SLE compared to controls. MiR126 was also higher in secondary APS patients compared to patients without. Serum IFN-α ws significantly higher in patients (71.2 ± 19.7 pg/ml) compared to control (43.2 ± 9.7 pg/ml) (p

PurposeDubai Quality Award (DQA) is one of the quality awards that has been implemented in the United Arab Emirates (UAE) for the purpose of improving organisational performance. The objective of this study is to determine whether receiving the DQA has positive impacts on Human Resource Development Practices (HRDP) and organisational performance (OP) of the award-winning companies.Design/methodology/approachSecondary data relating to DQA scores were collected from the Department of Economic Development archive of UAE and primary data relating to HRDP and OP were collected from the individual DQA recipients. Data elicited were subjected to statistical analyses by using the structural equation modelling (SEM) approach. This was to identify the nature of relationships existing between DQA criteria and organisational performance outcomes through the mediating effect of HRDP.FindingsThe results indicated that winning of DQA significantly enhances organisational performance and that HRDP is a statistically significant mediator between DQA and OP. Based on the findings of this study, a model has been developed by linking the DQA criteria, HRDP and organisational performance.Originality/valueDespite few of its limitations, this study is first of a kind in UAE that investigated the relationships among DQA criteria, HRDP and OP. The findings are expected to help the UAE companies to adjust their management policies and practices for enhancing their organisational performance. The findings can also be applicable to companies in other countries, especially Gulf countries that have similar awards such as DQA.

Context: Transforming growth factor-β1 (TGF-β1), endothelin-1 and angiotensin II are responsible for extracellular matrix accumulation within the kidney in diabetic nephropathy.Objective: This study evaluated the effect of adding Gum Arabic (GA) and insulin on serum glucose, renal function, TGF-β1, endothelin-1, and angiotensin II in rats with diabetic nephropathy.Methods: Sixty male Sprague-Dawley rats were divided into; normal, normal plus GA, diabetic rats (DM), DM plus insulin, DM plus GA, and DM plus insulin plus GA groups. Levels of glucose and creatinine in serum, TGF-β1, angiotensin II, and endothelin-1 in renal homogenate and HbA1c were measured.Results: Serum creatinine, TGF-β1, angiotensin II, and endothelin-1 were increased in diabetic rats. GA decreased serum glucose, TGF-β1, angiotensin II, endothelin-1, and HbA1c in diabetic rats. GA and insulin decreased serum glucose, creatinine, TGF-β1, angiotensin II, endothelin-1, and HbA1c in diabetic rats.Conclusion: Co-administration of GA with insulin to rats with diabetic nephropathy improved the glycemic state, renal function, TGF-β1, endothelin-1, and angiotensin II.

Background: Development of many techniques conserve blood in cardiac surgery has been established, to avoid the side effects of homologous blood transfusion. One of these techniques is the Retrograde Autologous Priming (RAP); which is a blood conservation technique designed to decrease the severity of hemodilution during cardiopulmonary bypass and thus decreasing perioperative transfusions. Aim of Study: The aim was to examine the safety and efficacy of RAP and its role in decreasing adverse outcomes on body systems after cardiac surgery. Patients and Methods: This work was performed on 60 adult patients indicated for open heart surgery as valvular heart disease or coronary heart disease. 30 patients were operated using RAP technique and 30 patients using ordinary priming method of cardiopulmonary bypass (CPB). Results: The CPB mean time was significantly shorter in the RAP group. The hemoglobin (Hb) level and hematocrit (Hct) concentration in the perioperative and postoperative time as significantly higher in the RAP group also the platelet count was significantly higher in the RAP group (p 0.05) between the two groups. Conclusions: RAP is an efficient and economical method in limiting the amount of priming volume of the CPB system, causing less hemodilution, reducing intra- and postoperative blood transfusion and decreasing adverse effects of hemodi-lution on body systems.

Real-time measurements of key effluent parameters play a highly crucial role in wastewater treatment. In this research work, we propose a soft sensor model based on deep learning which combines stacked autoencoders with neural network (SAE-NN). Firstly, based on experimental data, the secondary variables (easy-to-measure) which have a strong correlation with the biochemical oxygen demand (BOD5) are chosen as model inputs. Moreover, stochastic gradient descent (SGD) is used to train each layer of SAE to optimize weight parameters, while a strategy of genetic algorithms to identify the number of neurons in each hidden layer is developed. A soft sensor model is studied to predict the BOD5 in a wastewater treatment plant to evaluate the proposed approach. Interestingly, the experimental results show that the proposed SAE-NN-based soft sensor has a better performance in prediction than the current common methods.

Background Perianal fistulas are a common inflammatory condition of the anal canal and perianal tissue. The introduction of MRI in the evaluation of suspected perianal inflammation has greatly improved the surgical outcome of these patients as it allowed the direct visualization of anal sphincters, levator ani muscle, and the extent of the disease in relation to these vital structures. Diffusion-weighted imaging (DWI) has been under extensive research to evaluate whether it adds any value in the setting of perianal inflammation. The aim of our study was to evaluate the visibility of perianal inflammation on DWI and evaluate the diffusion characteristics of perianal fistulas and abscesses and how accurately can DWI classify perianal disease. Results Mean age of patients was 37 ± 8.9 years old. The study included 30 fistulas and 15 abscesses. Seven patients had more than 1 fistula or fistula and abscess. Perianal abscesses were well visualized equally on DWI and T2W images and correctly classified by DWI, when compared to post-contrast images. Perianal fistulas without abscesses, on the other hand, had variable visibility scores. Although the visibility of these fistulas on DWI was generally less than T2W and combined DWI and T2W, yet this did not reach a significant level and it was not significantly different between positive and negative inflammatory groups. Combined DWI and T2W evaluation had the highest performance and accurately classified 97.8 % of perianal fistulas and abscesses, and only 1 case was misclassified (2.3%). Conclusion DWI had a good performance in the evaluation of perianal inflammatory disease. However, combined DWI and T2W evaluation had better performance which was not significantly different from combined T2W and post-contrast images.

This study aimed at investigating the efficacy and safety of dinoprostone 3 mg vaginally prior to levonorgestrel-releasing intrauterine system (LNG-IUS) insertion in women undergoing elective cesarean delivery (CD). We conducted a prospective, randomized, double-blinded, placebo-controlled trial at family planning clinic of Cairo University hospitals from August 2019 to January 2020. We included 200 women aged ≥ 18 years who previously delivered by elective CD willing to receive LNG-IUS. Women were randomly assigned with a 1:1 allocation ratio to receive 3 mg vaginal dinoprostone or placebo tablets two hours before LNG-IUS insertion. Our main outcomes were patient-reported pain during insertion and 30 min post-procedure, ease of insertion, satisfaction, duration of insertion, and different side effects. Patient-perceived pain during LNG-IUS insertion was significantly reduced in dinoprostone compared to placebo (4.1 ± 1.7 vs 6.4 ± 1.3; p

Introduction: Ventilator-associated pneumonia (VAP) is a nosocomial infection that develops 48 h after the initiation of mechanical ventilatory support. Current evidence-based guidelines demonstrate that VAP prevention is feasible through the implementation of certain VAP prevention bundle of interventions simultaneously. We aimed in this study to investigate the effect of VAP prevention pre- and post- implementation. Methods: This is a single-center, cohort study that took place at the Pediatric Intensive Care Unit (PICU) of King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia from January 2015 to March 2018 and assessed the rate of VAP before and after implementation of the bundle. Results: The study included 141 children, 95 were included from the pre-bundle group and 36 from the bundle group. VAP developed in 35% of the pre-bundle group compared to 31% of the bundle group (p = 0.651) with incidence rates equaled to 18 and 12 per 1000 ventilator days, respectively. Conclusion: This study found that VAP bundle did not significantly reduce VAP rate in the PICU. Further large prospective multi-center studies with longer intervention duration are indicated to investigate the benefits of using VAP prevention bundle. Keywords: Ventilator-associated pneumonia, VAP, VAP Bundle, PICU

INTRODUCTION: A plenty of materials have been used to increase the success rate, decrease time needed for osseointegration, stimulate bone formation around dental implants. Bisphosphonates increase bone mineral density by inhibiting osteoclast-mediated bone resorption. Alendronate sodium hydrate is a bisphosphonate that potently inhibits bone resorption and is used to treat osteoporosis. A 1% sodium alendronate gel is manufactured and tested in order to accelerate osseointegration around dental implants.OBJECTIVES: This study aims to compare clinically and radiographically the osseointegration for 2 groups of submerged dental implants both in upper anterior and premolar region, first group with the use of local sodium alendronate gel prior to placement of dental implant and the second group without.MATERIALS AND METHODS: A clinical trial on 24 implants divided into 2 groups indicated for dental implant placement in the upper anterior and premolar region selected from the outpatient clinic of the Oral and Maxillofacial department, Faculty of Dentistry, Alexandria University. For the test group 12 implants were placed with sodium alendronate gel just prior to implant placement. For control group 12 implants were placed without sodium alendronate gel.RESULTS: On the 12 week the resonance frequency analysis (RFA) median records were (55.50, 54.0) and the Mean ± SD (55.08 ± 4.94, 54.67 ± 5.69) for the control group and test group, respectively. The bisphosphonate-coated implants showed an increase in implant stability from 0 to 12 weeks more than the control's measures. On the 12 week, the mean peri-implant bone density value was 1417.92 ± 310.54 for control group and 1550.25 ± 286.15 for test group. These increases in the bone density were higher in test group than the control group.CONCLUSIONS: Using sodium alendronate gel with delayed implant placement could enhance the osseointegration around dental implants.

Defining the risks associated with diabetes mellitus in patients undergoing penile prosthesis implantation remains controversial. Our study aims to assess whether preoperative hemoglobin a1c and preoperative blood glucose levels are associated with an increased risk for postoperative infection in diabetic men. We performed a retrospective review of 932 diabetic patients undergoing primary penile prosthesis implantation from 18 high-volume penile prosthesis implantation surgeons throughout the United States, Germany, Belgium, and South Korea. Preoperative hemoglobin a1c and blood glucose levels within 6 h of surgery were collected and assessed in univariate and multivariate models for correlation with postoperative infection, revision, and explantation rates. The primary outcome is postoperative infection and the secondary outcomes are postoperative revision and explantation. In all, 875 patients were included in the final analysis. There were no associations between preoperative blood glucose levels or hemoglobin a1c levels and postoperative infection rates; p = 0.220 and p = 0.598, respectively. On multivariate analysis, a history of diabetes-related complications was a significant predictor of higher revision rates (p = 0.034), but was nonsignificant for infection or explantation rates. We conclude preoperative blood glucose levels and hemoglobin a1c levels are not associated with an increased risk for postoperative infection, revision, or explantation in diabetic men undergoing penile prosthesis implantation.

Microglial phagocytosis is rapidly emerging as a therapeutic target in neurodegenerative and neurological disorders. An efficient removal of cellular debris is necessary to prevent buildup damage of neighbor neurons and the development of an inflammatory response. As the brain professional phagocytes, microglia are equipped with an array of mechanisms that enable them to recognize and degrade several types of cargo, including neurons undergoing apoptotic cell death. While microglia are very competent phagocytes of apoptotic cells under physiological conditions, here we report their dysfunction in mouse and monkey (Macaca fascicularis and Callithrix jacchus) models of stroke by transient occlusion of the medial cerebral artery (tMCAo). The impairment of both engulfment and degradation was related to energy depletion triggered by oxygen and nutrients deprivation (OND), which led to reduced process motility, lysosomal depletion, and the induction of a protective autophagy response in microglia. Basal autophagy, which is in charge of removing and recycling intracellular elements, was critical to maintain microglial physiology, including survival and phagocytosis, as we determined both in vivo and in vitro using knock-out models of autophagy genes and the autophagy inhibitor MRT68921. Notably, the autophagy inducer rapamycin partially prevented the phagocytosis impairment induced by tMCAo in vivo but not by OND in vitro. These results suggest a more complex role of microglia in stroke than previously acknowledged, classically related to the inflammatory response. In contrast, here we demonstrate the impairment of apoptotic cell phagocytosis, a microglial function critical for brain recovery. We propose that phagocytosis is a therapeutic target yet to be explored and provide evidence that it can be modulated in vivo using rapamycin, setting the stage for future therapies for stroke patients.

Objective: Asthma is a chronic disorder of the airways, in which chemokines coordinate airway inflammation and determine its severity. We aimed to study the chemokine interferon-γ-inducible protein 10 kDa (IP10/CXCL10), a member of the CXC receptor 3 (CXCR3) ligand family, at the protein level in the serum of children, to evaluate the association between CXCL10 and exacerbations of childhood asthma.Methods: Patients experiencing an asthma exacerbation (42 patients) and stable patients (43 patients) were investigated for serum CXCL10 levels.Results: Patients with an asthma exacerbation expressed significantly higher CXCL10 levels in the serum than stable patients (P =

Background COVID-19 is a pandemic disease and is important to know the nature of the disease during follow-up. We aimed to study different imaging signs and changes that occurred during the initial scan, follow-up, and complications. Moreover, to study the CT severity score and its relation to the patients’ clinical condition using oxygen saturation as a parameter. This was a retrospective study conducted on 125 patients, including 293 CT studies, from March till the end of August 2020. The mean age was 47.4 ± 15.7 years and 64.8% of the patients were males. All patients proved to have COVID-19 by the RT-PCR test. The CT studies of the patients were divided into four stages according to the timing after the onset of symptoms. The incidence of different CT features, patterns, complications, CT severity score, and oxygen saturation were recorded in different stages. Results During follow-up studies, GGOs were the most constant and common CT features. Consolidation and crazy paving showed gradual progression to reach the peak at the 3rd stage. Mixed attenuation pattern was the commonest pattern at the 3rd stage while a pure GGO pattern was the commonest feature in other stages. The complications occurred mostly in the 3rd stage. Nevertheless, the CT severity score showed an inverse relation with oxygen saturation. Conclusion Radiological evaluation of COVID-19 pneumonia showed gradual progression till the peak critical stage at 8-14 days from the onset of symptoms. Consolidation and mixed attenuation pattern can be considered as CT signs of disease severity.

Background Implementing point-of-care multiorgan ultrasound (POCUS) to the initial assessment of ICU patients allows intensivists to immediately integrate ultrasound findings with the patient history, physical, and laboratory results, yielding a powerful clinical synergy, improving diagnostic accuracy, and ameliorating further management plans. The aim of this work was to assess the diagnostic performance and therapeutic effect of POCUS in patients admitted to respiratory ICU (RICU). Patients and methods A prospective study was carried out on patients admitted to the RICU. POCUS examination was performed to the patients within 12 h of admission that included echocardiography, lung ultrasound, abdominal ultrasound including inferior vena cava assessment and lower limb venous duplex. Results A total of 102 patients were included. The total number of sonographic findings was 320, of which 94 (29.3%) were new findings. This resulted in confirmation of the admitting diagnosis, modification of the admitting diagnosis, prompted further testing, change in medical therapy prescribed, and prompted invasive procedures in 35, 51, 11, 41, and 14% of patients, respectively. However, it was ineffective in confirming or modifying diagnosis, provided wrong diagnosis, and missed a diagnosis in 29.4, 2, and 11.7% of patients, respectively. Conclusion Integrating POCUS in the initial assessment of critically ill RICU patients together with standard diagnostic tests lead to diagnostic and therapeutic changes in most of patients which affected the management of these patients. Thus, it seems reasonable to consider the routine use of POCUS as a new respiratory examination option in the armamentarium of the intensivists.

Background Lung cancer is the leading cause of cancer related deaths worldwide. The combination of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) and computed tomography (CT) has a great impact on the diagnosis, staging, and hence on the treatment plan and follow up of lung cancer patients. Maximum standardized uptake value (SUVmax) is a semi-quantitative index which is easily performed and the most widely used quantitative parameter for the analysis of 18F-FDG PET images and for the estimation of metabolic activity. Objective to investigate the role of PET/ CT to differentiate between adenocarcinomas (AC) and squamous cell carcinomas (SCC) as the most common lung cancer by comparing their FDG uptake measured in the form of SUVmax. Methods A retrospective observational study, conducted at Ain Shams University Hospitals- Radiology Department patients diagnosed with non-small cell lung cancer (NSCLC) and histopathologically proved to be adenocarcinoma or squamous cell carcinoma. All were investigated using PET/CT scans in the period between June 2017 to September 2019. SUVmax of the lesion were measured and statistically analyzed compared with the histopathological type. Results A total of 30 patients were evaluated with the age ranging from 31 to 81 years old, the mean was 56.9 years (SD ± 11.53). Among them 25 patients (83.3%) were males and 5 patients (16.7%) were females. Out of the 30 NSCLC patients included in the study, 18 patients (60%) were histopathologically diagnosed as AC and 12 patients (40%) were histopathologically diagnosed as SCC. The mean SUVmax of the 30 NSCLC lesions was 15.02±8.4 (range: 2-32.8).The mean SUVmax of AC lesions was 12.4±7.55 (range: 2-32.8), while the mean SUVmax of SCC lesions was 18.95±8.3 (range: 3.7-30.77). The mean SUVmax of lesions in patients with SCC was significantly higher than that of patients with AC using Wilcoxon-Mann-Whitney test (P = 0.04). Conclusion SCC of the lung has higher SUVmax than AC of the lung and it can be used to differentiate between them using PET/CT.

Background Pulmonary involvement is the most common extra-articular manifestation of Rheumatoid arthritis. Aim of the Work To highlight the role of HRCT in detection and characterization of variable pulmonary manifestations that can be encountered in patients with Rheumatoid Arthritis trying to correlate the CT pulmonary manifestations with pulmonary functions using CT scoring system. Patients and Methods This was a retrospective study that included 32 patients who were diagnosed to have Rheumatoid Arthritis either outpatients or referred from the Rheumatology Department at Ain Shams University Hospitals to the Radiodiagnosis Department for HRCT chest examination. An acceptance from the ethical committee of Faculty of Medicine - Ain Shams University was obtained to use the data stored on PACs system with the patient’s consent was waived being a retrospective study. All patients underwent HRCT image analysis regarding the CT features and CT score for disease severity. Also, all patients did spirometery for pulmonary function assessment. Results Analyzing the data showed a female sex predominance (90.6%). 87% of the patients were diagnosed to have RA for more than 2 years duration. The most common respiratory symptom was dyspnea and the restrictive pattern was the commonest PFT finding. Ground glass pattern was the most common 78.1% followed by reticular pattern which was seen in 68.8% of patients. PFT and HRCT showed a positive correlation regarding the severity. Conclusion HRCT is a modality of choice for detection of pulmonary manifestation of rheumatoid arthritis patients with CT scoring can be used to assess the severity of disease and degree of lung involvement which is correlated with pulmonary function test.

Background Non neoplastic GI lesions in pediatrics are variable and differ in types and prevalence among each pediatric age group. Helicobacter pylori is an important pathogen that can cause gastritis and peptic ulcers in adults as well as in children. Celiac disease is a gluten-dependent autoimmune disorder which affects individuals having genetic susceptibility. Eosinophilic gastrointestinal diseases are disorders that primarily affect the gastrointestinal tract with eosinophil-rich inflammation in the absence of known causes for eosinophilia. Inflammatory bowel disease (IBD) is a chronic inflammatory disorder, mainly affecting the gastrointestinal tract with extraintestinal manifestations and associated immune disorders. It seems that it is one of the most common gastrointestinal diseases affecting children in the developed countries. Aim of the work To study different types of paediatric non neoplastic gastrointestinal lesions from gastrointestinal endoscopic biopsies received at the Pathology Department in Ain Shams University hospital during a period of 2 years (2017-2018), and to correlate them with the clinicopathological presentations and endoscopic findings. Patients and Methods A cross sectional study was conducted on all pediatric gastrointestinal biopsies received at Pathology Department in Ain Shams University Hospital during the period of two years (2017- 2018). Only cases with information for all the covariates (n = 580) were selected and the results were statistically analyzed. Results Total 580 pediatric cases were enrolled according to inclusion criteria. Nonspecific gastrointestinal inflammation represented (47.1%), Helicobacter pylori associated gastrointestinal inflammation represented (43.5%), Eosinophilic gastrointestinal disease represented (3.8%), Inflammatory bowel disease (IBD) represented (3.7%), Celiac disease represented (1.9%). Conclusion This is the first study conducted in Ain Shams University Hospitals to assess the different types of pediatric non neoplastic gastrointestinal lesions received with clinicopathological and endoscopic correlation. The most common pediatric non neoplastic GI lesion is Helicobacter pylori infection. The diagnosis of pediatric non neoplastic GI disorder necessitates interdepartmental teamwork between GI pediatricians and pathologists.

Background: The pathogenesis of rotator cuff tear (RCT) remains controversial. The acromion portion ofthe scapula and its morphology may be attributable for a variety of shoulder disorders such as RCT. Patients and Methods: This was a retrospective study that included 40 patients divided into two groups; a group with RCT included 20 patients and a control group with no RCT included the other 20 patients. 19 were males and 21 females, their age 20-69 years old with a mean age of 45. Cases were selected from the PACS system of the Radiology department of Ain Shams University Hospital. Statistical data analysis was done using IBM SPSS software package version 20.0. (Armonk, NY: IBM Corp) Results: The study revealed that Type Il acromion was encountered in most of the male patients (42.1%) and type Ill acromion was encountered in most of the female patients (42.9%) while type IV acromion was less frequently seen among males and females (5% & 0%) respectively. It also revealed that Type Ill is mostly encountered in RCT (50%); 58% of full-thickness tear and 37% of partial thickness tear. while type I is less frequently associated with a partial tear or full thickness tear (8%) for each. Acromion type Ill was the commonest type of acromion found between the patients of the case group with a significant statistical difference found between the case and control groups (P value: 0.006). However, type I acromion was the commonest acromion type found between the control group with also a significant statistical difference (P value: 0.011). Conclusion: Type Ill acromion may be a risk factor leading to rotator cuff tear. This may help guide therapy in patients with shoulder pain and findings suggesting type Ill acromion shape Keywords acromion shapes, magnetic resonance imaging, rotator cuff tear

Hemangiomas are very common benign vascular tumors of head and neck. Intraosseous hemangiomas are rare and very few cases of involvement of nasal bone have been found in literature. A slowly growing hard nasal mass should draw clinical suspicion and should be included in differential diagnosis as it carries with it the risk of uncontrollable hemorrhage during surgical procedures. Clinical examination and radiology are contributory but histopathological examination is confirmatory for diagnosis. Keywords: hemangiomas, intraosseous, nasal bone