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Early diagnosis is considered important for medical images of breast cancer, the rate of recovery and safety of affected women can be improved. It is also assisting doctors in their daily work by creating algorithms and software to analyze the medical images that can identify early signs of breast cancer. This review presents a comparison has been done in term of accuracy among many techniques used for detecting breast cancer in medical images. Furthermore, this work describes the imaging process, and analyze the advantages and disadvantages of the used techniques for mammography and ultrasound medical images. K-means clustering algorithm has been specifically used to analyze the medical image along with other techniques. The results of the K-means clustering algorithm are discussed and evaluated to show the capacity of this technique in the diagnosis of breast cancer and its reliability to identify a malignant from a benign tumor.

Introduction: Survivors of torture have high rates of mental health problems and can experience a sequela of physical effects with the most common being persistent pain. Similar to survivors of torture, persons that are incarcerated have high rates of mental health problems, persistent pain and pain-related disability.The purpose of this study is to assess the effect of an interdisciplinary group treatment approach, involving psychotherapy and physiotherapy, with survivors of torture whom are incarcerated in a prison in Kurdistan, Iraq. Methods: A parallel group study design was used to compare a treatment group (n=11) and a wait-list control group (n=16). The treatment group participated in an interdisciplinary treatment service for a total of 10 weekly group sessions for each discipline.The primary outcome measures were symptoms of nociplastic pain, anxiety, depression, and PTSD. Secondary outcome measures evaluated physical functioning, sleep quality, and general self-efficacy. Results: A statistically significant reduction in outcome measure scores was seen in all symptoms measured immediately post-treatment. Discussion and Conclusion: These findings suggest that a culturally and contextually appropriate interdisciplinary group treatment intervention for survivors of torture in a prison could be effective for short-term reductions in symptoms of anxiety, depression, PTSD, persistent pain, and function. The study has limitations including a small sample size, lack of long-term outcome measures, and an inability to isolate effect of each component of care. The study does demonstrate the feasibility of implementing research that follows international research standards and practices within under-researched settings and post-conflict areas.

Background: Breast cancer related lymphedema represents a major complication of breast cancer treatment, impacting the quality of life of breast cancer survivors. Patients with lymphedema need to conduct lifelong self care activities to control the progression of swelling, manage lymphedema-associated symptom burden, and minimize long term negative outcomes. Aim: This study aimed to assess knowledge and self care practices of women with breast cancer related lymphedema. Study design: A descriptive study design was utilized to conduct this study. Setting: This study was conducted in the outpatient breast clinic at Oncology Center and Nuclear Medicine, affiliated to Ain Shams University Hospitals. Subjects: A purposive sample of 50 women newly diagnosed with breast cancer related lymphedema, post mastectomy, and treated with radiotherapy. Data collection tools: A structured interview questionnaire for women with breast cancer related lymphedema, and self care practices questionnaire. Results: The mean age of the studied women was 47.71±7.16, and about one fifth of them had satisfactory level of total knowledge regarding breast cancer related lymphedema, also; the minority of them had adequate level of total lymphedema self care practices. Moreover there is statistically significant difference between the self care practices of the studied women and their educational level. Conclusion: The majority of the studied women had unsatisfactory knowledge regarding breast cancer related lymphedema, and almost of them had inadequate lymphedema self care practices. Recommendations: Educational programs about lymphedema and risk reduction methods after the breast surgery are strongly needed. Also, continuous in service educational programs should be held for all the health care team working in breast cancer units. In addition, further researches are recommended to assess barriers to self care among patients with breast cancer related lymphedema.

Background: Subcutaneous enoxaparin administration often causes problems such as pain; bruise and hematoma at the injection sites. In terms of these problems, cold application has been found to have various therapeutic benefits as relieve pain by produce localized anesthetic effect and controls bleeding by causing vasoconstriction. Aim of the study: To investigate the effect of cold application on local problems among patients receiving subcutaneous enoxaparin. Design: Self controlled trial design was utilized. Setting: The study was carried out in general surgery department, orthopedic surgery department, and chest Intensive Care Unit at Beni-seuf University Hospital. Study subjects: A purposive sample of 60 patients was included in the study. Data collection tools: Data were obtained through Patient assessment tool, Bruising Category Scale, Visual Analogue Scale for pain and Hematoma Formation Scale. Results: All studied patients had pain and more than half developed bruise at injection site when they received enoxaparin without cold application but more than three quarter of studied patients had pain and less than one quarter developed bruise when they received injection with cold application. Meanwhile, the majority of the studied patient did not develop hematoma whether cold applied at injection site or not. Conclusion: The pre-injection cold application at enoxaparin injection site was effective in reducing the occurrence of pain and bruising. Moreover, there was statistically significant relation between the patients’ pain intensity, the size of bruising and their demographic characteristics; age and gender. Recommendations: Cold application should be included in standard protocol for the administration of SC enoxaparin and providing on-going and regular in-service educational programs about it for nurses.

Heart disease is one of the most common causes of death worldwide. Real-time methods for forecasting heart disease from medical data sources that explain a patient's current health status are discussed in this paper. The proposed system's main aim is to find the best data mining algorithm for predicting heart disease with high accuracy. We suggested using Decision Tree (DT), Support Vector Machine (SVM) and Naive Bayes (NB) algorithms. All of these algorithms are classified as supervised learning and work better with training data. The main purpose of using three algorithms is to see which one is the best at predicting heart disease. The result shows that the DT algorithm provides the best accuracy with less training time when compared to SVM and Naive Bayes(NB).

Context: Hepatocellular carcinoma (HCC) is considered one of the most challenging tumors with high incidence, prevalence, and mortality rates. Radiofrequency Ablation (RFA) is one of the emerging therapeutic modalities used for the minimally invasive treatment in the management of early-stage HCC. Aim: This study aimed to assess the effect of self-care guidelines on quality of life for patients with Hepatocellular Carcinoma undergoing Radio Frequency Ablation. Methods: A quasi-experimental design was used to achieve the aim of this study. This study was conducted at the Interventional Radiology Unit, affiliated to Ain Shams University Hospital, on a purposive sample of 50 patients with hepatocellular carcinoma; 25 randomly allocated to the study group, and 25 allocated to the control group. A structured interview questionnaire for patients with hepatocellular carcinoma undergoing radiofrequency ablation was used to collect the study data. It comprises three parts: Sociodemographic characteristic, assessment of patients' medical health, and knowledge about HCC and RFA. The second tool was the quality of life of cancer survivors questionnaire (pre /posttest), and finally, a patient-reported self-care practices assessment checklist (pre /posttests). Results: There were statistically significant differences between the study and control groups regarding their total knowledge about hepatocellular carcinoma and radiofrequency ablation therapy pre and post-implementation of self-care guidelines. There were highly statistically significant differences between both groups regarding the total quality of life, pre and post-implementation of self-care guidelines. In addition, there were highly statistically significant differences regarding total self-care practice, pre, and post-implementation of self-care guidelines. A positive correlation was revealed between total knowledge with total self-care practice and total quality of life (pre/posttest). Also, a significant correlation was revealed between the total quality of life and self-care practices post self-care guidelines implementation at (p

Background: Non-Hodgkin's lymphoma patients undergoing chemotherapy have symptoms that continue to place a significant burden and preventing them from living normally. This requires non-hodgkin's lymphoma patients to engage in a range of self-management actions. The aim of this study was to assess the effect of self-management guidelines on chemotherapy associated symptoms among non-Hodgkin lymphoma patients. Design: A quasi experimental design. Setting: the study was conducted at the hematology unit in Ain Shams University Hospital. Subjects: A purposive sample of 76 adult patients. Data collection tools: Three tools were used in this study, structured interview questionnaire for the non-hodgkin's lymphoma patients undergoing chemotherapy, self-care practices questionnaire, and symptoms experience tools. Results: Regarding total level knowledge, 28.9% of the studied patients had satisfactory level of total knowledge pre implementation of self-management guidelines which improved to 65.8% with a highly significant difference post implementation of self-management guidelines (P≤ 0.001). While 26.3% of the studied patients had satisfactory level of total self-care practices pre implementation of self-management guidelines which improved to 57.9% with a highly significant difference post implementation of self-management guidelines (P≤ 0.001). There was a significant improvement on patients` symptoms experience post implementation of self management guidelines. Conclusion: The implementation of self-management guidelines for patients with non-Hodgkin's lymphoma undergoing chemotherapy has a statistically significant positive effect on their knowledge, self-care practice and associated symptoms which support the stated hypothesis. Recommendation: This study recommends the importance of developing tailored self-management programs for fatigue, nausea, vomiting and oral mucositis to understand and promote chemotherapy associated symptoms self-management in patients with non-hodgkin's lymphoma disease.

Background: Hospital acquired anemia (HAA) is one of the most common intensive care unit (ICU) acquired complications that associated with poor outcomes, increase morbidity and mortality for critically ill patients. Factors contribute to its development include profound loss of RBCs or insufficient RBCs production. Aim of the study: to assess factors contributing to HAA among critical ill patients. Design: A descriptive exploratory design was utilized. Setting: The study was carried in Beni –Suief university hospital inside the critical care units which include; general ICU, cardio care unit (CCU) and chest ICU. Study subjects: purposive sample of 75newly admitted adult critically ill patients to the above mentioned sitting was included in the study. Data collection tools: Data were obtained through patients assessment tool, factors contributing to HAA and indicators of HAA tool. Results: reveals that, nearly one third of studied patients their age were more than or equal fifty years. As regard to gender, the results revealed that, more than half of them were males, nearly one third of anemic patients had HAA in the 5th day from admission to hospital. As well more than three quarter of anemic patients were under feeding and more than one third of them had sepsis, in addition to mean amount of blood loss for anemic patients exceed amount of blood loss for non anemic patients. Conclusion: More than half of studied patients developed HAA during their ICU stay. Even, non-anemic patients were subjected to a decline in their Hb level. As well as, there were statistically significant relation between nutrition deficiency, sepsis, blood loss in ICU and drugs increase RBCs loss factors and occurrence of HAA. Also there were insignificant relation between demographic characteristic of studied patients, their diagnosis on admission to hospital, hemodilution, drugs affect RBCs production and occurrence of HAA. Recommendations: Designing in-service training and educational program for nurses about blood conversation strategies especially prevention of blood loss associated invasive procedure and phlebotomy practice.

Objectives:Patients with impaired renal functions have a variable risk of morbidity and mortality in cardiovascular surgery. Poor outcome was reported among patients who underwent valve surgery. Current study is presumed to compare the early outcomes of patients having different degrees of impaired renal functions and undergoing mitral valve replacement surgery. Methods:135 patients were admitted into the three highly specialized centers in Cairo and Ismailia–Egypt between Dec.2018 and Jan.2020 Preoperative, intraoperative and early post-operative data were recorded. Impairment may present as one of these strata: early reversible (G1-2 included strata 1 & 2 kidney disease patients), moderate G3-4 included strata 3 & 4 kidney disease patients) or advanced irreversible renal damage. (The 5th stratum or G5-KD included end stage renal disease patients undergoing 4-hour hemodialysis sessions, three times a week, with bicarbonate dialysate). We correlated outcome among each stratum with cardiac and renal functions in that stratum. Results:The more is the impairment of renal functions at any peri- operative stage, the longer is the need for prolonged mechanical ventilation and the longer is the hospital stay. We found that levels of serum creatinine were significantly increased postoperatively Also, the more is the reversibility of the renal impairment, even by renal dialysis, the much better is the outcome (P=.0019). We also found insignificant difference between different strata of irreversible renal impairment in the early outcome of the prosthetic mitral valve replacement surgery. The early reversible damage can be repaired peri-operatively. Conclusions:Prosthetic mitral valve replacement among patients with different degrees of impaired renal functions is not only feasible but also it does not seem to add any more deterioration into renal function. Prolonged mechanical ventilation and hospital stay are the only drawbacks of irreversibly impaired renal damage by dialysis or renal transplant.

Objective: This cross-sectional study was conducted from July to November 2015 to estimate the prevalence of anti-toxopalsma antibodies in sheep and goats in El-Gadarif state. Material and methods: A total of 400 serum samples comprising of 200 sheep and 200 goats were collected and tested by Toxo-latex agglutination test and indirect enzyme linked immunosorbent assay (iELISA). Results: The overall sero-prevalence was 52.0% (n=208/400) using Toxo-latex agglutination test and 45.7%(n=42/92) and 27.2%(n=25/92) using iELISA in sheep and goats, respectively. Furthermore, the sero-prevalences among the two investigated species and the two age groups were statistically similar but were different between localities, breeds and sexes. In the univariate analysis, species (P=0.028) and locality (P=0.001) were associated with Toxo-latex agglutination test positive status. Additionally, species (sheep) and locality (Al-Fao, Al-Hawatah, and West El-Gadarif) had increased odds of being Toxo-latex agglutination test positive in the multivariate analysis. Conclusion: It can be concluded that the prevalence of anti-toxopalsma antibodies is relatively high and there was no between-species variation in sero-positivity. These findings warrant further investigations to estimate the burden of the disease and the likelihood of zoonotic transmission. http://doi.org/10.5455/javar.2017.d205 XML PubReader

Scientific knowledge has advanced to enable the development of inhaled insulin. It is a form of diabetes medication administered via the pulmonary system that studies have shown to be efficacious in the treatment of both type 1 and type 2 diabetes. Inhaled insulin is a new, safe means to deliver insulin that may increase patient compliance with insulin therapy, helping them to achieve optimal glycemic control and possibly reducing their risk of developing cardiovascular complications. However, diabetes is a chronic illness requiring lifetime intervention. Empowering patients with the knowledge of the diabetes disease process may give them the confidence to be more autonomous in managing their diabetes. HIIP gives nurse practitioners a new option that may improve their patients’ acceptance of insulin therapy, and improve glycemic control.

Background and objective: The goal of this study was to determine the association of complete left bundle branch block (LBBB), site , severity & risk factors of coronary artery disease (CAD). Complete Left bundle branch block increases the risk of cardiac mortality, and prognosis is primarily determined by the underlying CAD. Because the presence of complete LBBB makes the noninvasive identification of CAD less informative, patients with complete LBBB often are referred for coronary angiography to assess the presence and severity of CAD. Methods: A total of 150 consecutive patients with complete LBBB admitted to the coronary care unit were enrolled from the age of 27 to 81 years with the mean age of 59.32 ± 10.5. Male 84 (56%), Female (44%). History, basal investigations echocardiography and virology screen were performed. Coronary angiography has been done for all patients for different reasons of presentation. Results: Critical CAD 70 (46.7%), Left ventricular systolic dysfunction (LVSD) 50 (33.3%). Hypertension found in 83 (55.3%), diabetes mellitus (DM) in 44 (30%), DM& left ventricular systolic dysfunction(LVSD) were more associated with critical CAD. Conclusion: In our study complete LBBB was more common among hypertensive patients. In DM patients was associated with severe CAD. With Left anterior descending artery being the most common artery involved.

Background: The Western-style diet is characterised by the high intake of energy- -dense foods. Consumption of either high-fructose diet or saturated fat resulted in the development of metabolic syndrome. Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome. Many researchers studied the effect of high-fat diet (HFD), high-fructose diet (HFruD) and high-fructose high-fat diet (HFHF) on the liver. The missing data are the comparison effect of these groups i.e. are effects of the HFHF diet on the liver more pronounced? So, this study was designed to compare the metabolic and histopathological effect of the HFD, HFruD, and HFHF on the liver. The proposed underlying mechanisms involved in these changes were also studied. Materials and methods: Twenty four rats were divided into four groups: con- trol, HFD, HFruD, and HFHF. Food was offered for 6 weeks. Biochemical, light microscopic, immunohistochemical (Inducible nitric oxide synthase [iNOS] and alpha-smooth muscle actin [ α -SMA]), real-time polymerase chain reaction (gene expression of TNF- α , interleukin-6, Bax, BCL-2, and caspase 3), histomorphometric analysis and oxidative/antioxidative markers (thiobarbituric acid reactive substances [TBARS], malondialdehyde [MDA]/glutathione [GSH] and superoxide dismutase [SOD]) were done. Results: The HFD, HFruD and HFHF groups developed a cluster of liver disorders; steatosis, necrosis, inflammation, apoptosis, ballooning degeneration and cytopla- smic vacuolations. Internal metabolic impairments include elevated serum levels of glucose, triglycerides, low density lipoprotein and decreased serum levels of high density lipoprotein and albumin. The immunoreaction of the α -SMA and iNOS was strong in these groups. The oxidant markers (MDA and TBARS) were elevated, while the antioxidant markers (SOD and GSH) were decreased. The area per cent of collagen, inflammatory markers, caspase 3 and Bax were elevated, while the BCL-2/Bax ratio was decreased. The decrease in PAS, antioxidant markers and the elevation of the α -SMA, iNOS, inflammatory and oxidant markers were obvious in the HFHF when compared to that of the other groups. Conclusions: High-fat diet, HFruD, and HFHF developed morphologic hepatic changes ranging from steatosis to necrosis and inflammation, besides the deve- lopment of internal metabolic impairments. The chief factors of hepatic injury were fat accumulation in the hepatocytes, oxidative stress and highly elevated iNOS. Compared to the other groups, HFHF’s effect was more prominent.

The present work aimed to investigate the cellular and immunochemical pattern of T cells population in biopsy material from chronic schistosomiasis haematobium Egyptian patients complicated with bladder cancer. Digital real-time quantitative photocytometry was applied to auto-analyze 29 stained tissue sections from cases and 17 controls using STAT4, GATA3, FOXP3, and CD8 markers specific for Th1, Th2, T regulatory, and T cytotoxic cells, respectively. Area percentage showed significant high level of GATA, followed by FOXP3 and low level of both STAT and CD8 was reported. Tissue samples from five healthy bladder tissues showed significant lower optical density (OD) values. Tissue samples from 12 non-bilharzial bladder cancers showed variable OD values, reflecting wide disparity in the control group. Our results hypothesized an exclusive pattern of T population in long standing complicated schistosomiasis haematobium. Our cases were poorly controlled by unbalanced Th1/Th2 in which Th2 was dominated. FOXP3 increased significantly, however, failed to downregulate Th2, instead, the relation between Th1 and T cytotoxic was forcibly limited by the high level of FOXP3, resulting in loss of their power in defending the host against both parasite and carcinogenic changes. These results provide more clarification for the immune evasion process played by the parasite and tumor cells under the supervision of T regulatory cells. Additionally a critical role of FOXP3 is suggested in manipulating STAT4 and CD8 in favor of malignant transformation in this life-threatening parasite.