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Abstract Background Hydroxyapatite (HAP) resembles the components of biological hard tissue. Recent research has been interested in the biomedical application of HAP nanoparticles (HAP-NPs) in cancer treatment, HAP-NPs have high cytotoxic activity against cancerous cells, in addition, they are nontoxic to healthy normal cells, biocompatible, biodegradable, and have a high absorption rate within the tissue. Therefore, this study evaluated HAP-NPs' antitumoral activity in Ehrlich solid carcinoma (ESC)-bearing mice, in addition, we examined the anticancer efficacy of combined treatment of a common chemotherapeutic drug such as Cisplatin (CDDP) and HAP-NPs in ESC-bearing mice. Methods Forty female mice were inoculated with 200 µl of diluted ascites fluid containing approximately two million viable cancer cells in the mice's left thigh, after 14 days of inoculation, the mice were distributed into four groups: 10 mice in each. ESC group was administrated distilled water, the HAP-NPs group was treated orally with 100 mg/kg of hydroxyapatite nanoparticles, the CDDP group was administrated intraperitoneally with 5 mg/kg of Cisplatin, the HAP-NPs + CDDP group was treated with both doses of hydroxyapatite and cisplatin, the animal treatment was conducted for 20 days. Antitumor activity was assessed for two durations after 10 and 20 days. DNA damage assessment was performed using comet assay in ESC, in addition, we measured the expression of the following genes (P53, Bcl2, and Bax,) using quantitative real-time PCR, and the apoptotic-related proteins (P53 and Ki-67) using immunohistochemical analysis. A histopathological examination of ESC was performed. Results The obtained data illustrated a promising anticancer activity of HAP-NPs, and the combined treatment of HAP-NPs and CDDP illustrated a higher anticancer efficacy. HAP-NPs, CDDP, and HAP-NPs + CDDP resulted in significant (P

Abstract Background Endotracheal intubation (ETI) is a life-saving procedure that must be accurately carried on to guard against complications. Presbyopia leads to difficulty in viewing close objects and may obstacle proper intubation even with the best hands. Purpose This study supposed that the use of video-laryngoscope (VL) may provide better intubation conditions for presbyopic anesthetists and targets to evaluate the neonates and infants’ intubation success rates (ISR) by anesthetists aged ≥ 45 years using the C-MAC VL compared to the standard laryngoscope (SL). Methods Thirty-one neonates with an age of 18.2 ± 5.2 days and a body weight of 4.5 ± 0.3 kg and 103 infants aged 8.6 ± 1 months and weighing 9.4 ± 1.5 kg were randomly categorized into the SL group that received ETI using the SL and the VL group had intubated using the C-MAC® (Karl Storz, Germany) VL with the standard Miller blade and flexible Stylet (2 mm PORTEX® stylet; Smiths Medical International Ltd., UK) to strengthen the endotracheal tube (ETT) and adjust its curvature as C-shaped. The study outcomes included the frequency of successful intubation and the number of intubation attempts. Results The ISR was significantly (P

Abstract Parasites have attained a life-long stigma of being detrimental organisms with deleterious outcomes. Yet, recently, a creditable twist was verified that can dramatically change our perception of those parasites from being a source of misery to millions of people to a useful anti-cancerous tool. Various parasites have shown promise to combat cancer in different experimental models, including colorectal, lung, and breast cancers, among others. Helminths and protozoan parasites, as well as their derivatives such as Echinococcus granulosus protein KI-1, Toxoplasma gondii GRA15II, and Trypanosoma cruzi calreticulin, have demonstrated the ability to inhibit tumor growth, angiogenesis, and metastasis. This article provides an overview of the literature on various cancer types that have shown promising responses to parasite therapy in both in vitro and in vivo animal studies. Parasites have shown anti-neoplastic activity through a variety of mechanisms that collectively contribute to their anti-cancer properties. These include immunomodulation, inhibition of angiogenesis, and molecular mimicry with cancer cells. This review article sheds light on this intriguing emerging field and emphasizes the value of collaborative multidisciplinary research projects with funding agencies and pharmaceutical companies. Thus, these strategies would secure continuous exploration of this new avenue and accelerate the advancement of cancer therapy research. Although experimental studies are heavily conducted by leaps and bounds, further steps are definitely lagging. Upgrading research from the experimental level to the clinical trial would be a wise progression toward efficient exploitation of the anti-neoplastic capabilities of parasites, ultimately saving countless lives.

Abstract Background Fibromyalgia is a chronic, disabling disorder of widespread musculoskeletal pain. It is generally considered a stress-related syndrome. Healthcare workers are prone to mental and physical stress due to due to excessive work burdens, long working hours, and a lack of balance between work and social life. Objective The aim of this study was to examine the prevalence of fibromyalgia and its predictors among Egyptian physicians. Methods Six hundred and ninety-one Egyptian physicians completed an online survey which included a self-reported fibromyalgia rapid screening tool (FiRST) as well as demographic (sex and age), health-related (chronic illnesses if any), and employment data (workday length, specialty, and employer). Logistic regression was performed to explore possible predictors of fibromyalgia. Results Fibromyalgia was observed in 13.2% of participants, with a female to male ratio of 3.8:1. Predictors of FM in this cohort included the following: female sex (odds ratio (OR) 2.2, 95% confidence interval (CI) 1.2–3.9, p = 0.014), age 41–50 years (OR 3.8, 95% CI 1.5–9.6, p = 0.005), concomitant chronic illness: endocrinopathies (other than diabetes mellitus) (OR 2.69, 95% CI 1.09–6.64, p = 0.035), musculoskeletal disorders (OR 5.60, 95% CI 2.96–10.6, p

Abstract Background Hemogram indices are simple, economic indicators of the systemic inflammation characteristic of autoimmune diseases including vasculitides. The clinical utility of hemogram indices in hepatitis C virus-related vasculitis (HCV-V) has not been established. This study aimed to evaluate neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), neutrophil/hemoglobin ratio (NHR), platelet/hemoglobin ratio (PHR), and systemic immune-inflammation index (SII) as potential biomarkers of HCV-V, and their relationship with disease activity. This cross-sectional case–control study was conducted in the departments of Rheumatology and Rehabilitation and Hepatogastroenterology, at Cairo University Hospital. Patients with HCV-V, patients with HCV infection free from extrahepatic manifestations (HCV sine vasculitis), and healthy control subjects were recruited. HCV-V activity was assessed using the Birmingham Vasculitis Activity Score (BVAS). Results Twenty-four HCV-V patients, 21 HCV sine vasculitis patients, and 40 healthy controls were recruited. Age and sex distribution was similar across groups. In HCV-V patients, NLR, PLR, NHR, and SII were higher than healthy controls, with NLR (area under curve (AUC) 0.94, p = 0.002), PLR (AUC 0.72, p = 0.007), NHR (AUC 0.89, p

Background/Objectives: Mirtazapine (MRZ) is a psychotropic drug prescribed to manage serious sorts of depression. By virtue of its extensive initial-pass metabolic process with poor water solubility, the ultimate bioavailability when taken orally is a mere 50%, necessitating repeated administration. The current inquiry intended to fabricate nose-to-brain chitosan-grafted cationic leciplexes of MRZ (CS-MRZ-LPX) to improve its pharmacokinetic weaknesses and boost the pharmacodynamics aspects. Methods: Primarily, MRZ-loaded leciplexes (MRZ-LPXs) were fabricated and tailored employing a central composite design (CCD). Vesicle diameter size (VS), entrapment efficiency (EE %), cumulative MRZ release percentage (CMRZR %), and total quantity penetrating after twenty-four hours (Q24) were the four parameters assessed. Then, the determined optimum formulation was coated with chitosan (CS-MRZ-LPX) and utilized in pharmacodynamics investigations and in vivo biologic distribution studies in Wistar male rats. Results: The customized MRZ-LPX formulation had a diameter size of 186.2 ± 3.5 nm and drug EE of 45.86 ± 0.76%. Also, the tailored MRZ-LPX formulation had a cumulative amount of MRZ released of 76.66 ± 3.06% and the total Q24 permeated was 383.23 ± 13.08 µg/cm2. Intranasal delivery of the tailored CS-MRZ-LPX revealed notably superior pharmacokinetic attributes inside the brain and circulation compared to the orally administered MRZ suspension and the intranasal free drug suspension (p < 0.05); the relative bioavailability was 370.9% and 385.6% for plasma and brain, respectively. Pharmacodynamics’ and immunohistopathological evaluations proved that optimum intranasal CS-MRZ-LPX boosted antidepressant activity compared to the oral and free nasal drug administration. Conclusions: CS-MRZ-LPX tailored formulation can potentially be regarded as a prospective nano platform to boost bioavailability and enhance pharmacodynamics efficacy. Ultimately, intranasal CS-MRZ-LPX can be considered a promising avenue for MRZ targeted brain delivery as an antidepressant.

Background/aim Acrylic resin denture base material with all its varieties and curing techniques enormously influence their physical, biological, and mechanical properties. This study designed to evaluate and compare the impact of acrylic resin reinforcement with titanium oxide nanoparticles (TiO2NP) on physical, biological, and mechanical criteria of two dissimilar denture base materials. Materials and methods This study was constructed on 120 specimens of 2 different types of acrylic resin denture base materials. The specimens were divided equally into 2 groups (60 each), group I (heat cured acrylic resin) and group II (microwave cured acrylic resin). Each group was additionally divided into two subgroups (each 30). Subgroup A as control, while subgroup B was modified with 3% TiO2NP. Biological evaluation was performed on Enterococcus faecalis by using antimicrobial assay by agar diffusion test color stability via employing spectrophotometer, and the Modulus of elasticity through universal testing machine. Results Regarding the results of biological assessment, groups IA and IIA (control groups) revealed no inhibitory zone, while groups modified with 3% TiO2NP group IIB demonstrated significantly higher (P < 0.05) inhibitory zone when compared with group IB. Concerning color stability, Regarding color stability, Group IA and IIA (control groups) demonstrated the highest color changes, while Group IB and IIB(modified groups) demonstrated the lowest color changes. In modulus of elasticity, groups IB and IIB were significantly higher (P

Abstract Two 3D-supramolecular coordination polymers (SCP1 & SCP2) have been synthesized and characterized by physicochemical and spectroscopic methods. In a solution of 1.0 M HCl, SCPs were used to prevent corrosion of carbon steel (CS). The inhibition productivity (%η) rises as the synthetic inhibitor dose rises, and the opposite is true as the temperature rises. The study was carried out using chemical (mass loss, ML) and electrochemical ( potentiodynamic polarization, PDP and electrochemical impedance microscopy, EIS) techniques, which showed %η reached to 93.1% and 92.5% for SCP1 & SCP2, respectively at 21 × 10−6 M, 25 °C. For the polarization results, SCPs behave as mixed-type inhibitors. With increasing doses of SCPs, the charge transfer resistance grew and the double layer's capacitance lowered. The creation of a monolayer on the surface of CS was demonstrated by the finding that the adsorption of SCPs on its surface followed the Henry adsorption isotherm. The parameters of thermodynamics were computed and explained. The physical adsorption of SCPs on the surface of CS is shown by the lowering values of free energy (∆Go ads

Good visibility of lane markings is important for all road users, particularly autonomous vehicles. In general, nighttime retroreflectivity is one of the most challenging marking visibility characteristics for agencies to monitor and maintain, particularly in cold weather climates where agency snowplows remove retroreflective material during winter operations. Traditional surface-applied paint and glass beads typically only last one season in cold weather climates with routine snowplow activity. Recently, transportation agencies in cold weather climates have begun deploying improved recessed, durable pavement markings that can last several years and have very high retroreflective properties. Several dozen installations may occur in a state in any calendar year, presenting a challenge for states that need to program annual repainting of traditional waterborne paint lines, but not paint over the much more costly durable markings. This study reports on the utilization of mobile mapping LiDAR systems to classify and evaluate pavement markings along a 73-mile section of westbound I-74 in Indiana. LiDAR intensity data can be used to classify pavement markings as either tape or non-tape and then identify areas of tape markings that need maintenance. RGB images collected during LiDAR intensity data collection were used to validate the LiDAR classification. These techniques can be used by agencies to develop accurate pavement marking inventories to ensure that only painted lines (or segments with missing tape) are repainted during annual maintenance. Repeated tests can also track the marking intensity over time, allowing agencies to better understand material lifecycles.

The effect of different contents of fullerene on the properties of polyurethane resins (PUs), including rheology and thermal properties, was investigated. Polyurethane resins were prepared through polyaddition reactions using different isocyanate monomers such as isophorone diisocyanate (IPDI), methylene diphenyl diisocyanate (MDI), hexamethylene diisocyanate (HDI), and different polyols, such as poly(oxytetramethylene) glycol (PTMG), the triol trade name FA-703, and polypropylene glycols (PPG), at an NCO/OH ratio 0.94 and a temperature of 100 °C. IR spectroscopy was used to control the polymerization of PUs through the shifting of NCO peaks. The results showed that the rheology and thermal properties of the prepared PU resins depend on the type of isocyanates and fullerene used. Based on the type of isocyanates, the PU resin prepared by MDI has the highest viscosity and thermal stability compared to the other isocyanates investigated. On the other hand, the PU resins prepared by IPDI mixed with fullerene had the highest viscosity and thermal stability. However, the initial decomposition temperature (T onset) of the PUs decreased with the addition of fullerene without affecting the maximum decomposition temperature (PDTmax) of the PU resin.

This study investigates the relationship between economic policy uncertainty (EPU) and the cost of equity capital (CoEC). It also reveals the moderating role of managerial ability (MA) in the relationship between EPU and CoEC in Saudi Arabia. The study sample consists of listed non-financial firms in Tadawul from 2008 to 2019. We analyzed data using STATA, depending on Pearson correlation analysis, two independent sample t-tests, OLS regression, and OLS with robust standard errors clustered by firm. Our study shows a positive effect of EPU on the CoEC. In addition, the results confirm that MA mitigates the positive effect of EPU on the CoEC. This is the first research to investigate the influence of the relationship between EPU on CoEC in Saudi Arabia, one of the largest emerging economies in the Middle East and Gulf countries. Our findings motivate decision-makers to strengthen their MA and establish a safe and stable investment environment to ensure better financing and investment decisions during uncertain times. Lending agencies, investors, and other stakeholders should consider the MA of corporations when making investment decisions.

The present research emphasizes fabrication alongside the assessment of an innovative nano-vesicular membranous system known as invasomes (NVMs) laden with Mirtazapine for rectal administration. This system could circumvent the confines of orally administered counterparts regarding dose schedules and bioavailability. Mirtazapine invasomes were tailored by amalgamating phospholipid, cineole, and ethanol through a thin-film hydration approach rooted in the Box–Behnken layout. Optimization of composition parameters used to fabricate desired NVMs’ physicochemical attributes was undertaken using the Design-Expert® program. The optimal MRZ-NVMs were subsequently transformed to a pH-triggered in situ rectal gel followed by animal pharmacodynamic and pharmacokinetic investigations relative to rectal plain gel and oral suspension. The optimized NVMs revealed a diameter size of 201.3 nm, a z potential of −28.8 mV, an entrapment efficiency of 81.45%, a cumulative release within 12 h of 67.29%, and a cumulative daily permeated quantity of 468.68 µg/cm2. Compared to the oral suspension, pharmacokinetic studies revealed a 2.85- and 4.45-fold increase in calculated rectal bioavailability in circulation and brain, respectively. Pharmacodynamic and immunohistopathology evaluations exposed superior MRZ-NVMs attributed to the orally administered drug. Consequently, rectal MRZ-NVMs can potentially be regarded as a prospective nanoplatform with valuable pharmacokinetics and tolerability assets.

Nanoparticle foliar spray is a new approach and effective for improving seedling growth and survival with adverse conditions such as salt stress. The current study was conducted to investigate the impact of commercial silicon dioxide (SiO2), SiO2 nanoparticles (SiO2 NPs), commercial chitosan (CS), CS nanoparticles (CS NPs) on growth, proline, antioxidant defense enzyme, and ions content in one-year-old for sour orange (Citrus aurantium, L.) and Volkamer lemon (Citrus volkameriana) rootstocks grown under salinity stress. In the current study, a foliar spray of bulk SiO2, SiO2 NPs, Chitosan, and Chitosan NPs with a concentration of 50 ppm was applied at 0 and 50 mM of NaCl concentrations. Vegetative growth was determined, including plant height, stem diameter, leaf area, roots, and total fresh and dry weights. The findings demonstrated that salinity adversely affected plant growth. Salt-stressed plant leaves exhibited greater peroxidase (POD) activity and proline content than the control treatment, and Na+ and Cl- ions accumulated in the leaves of salinized plants. Nano-Silicon dioxide and Nano-chitosan significantly increased full vegetative growth parameters and antioxidant defense enzymes. Nano treatments decreased Na+ and Cl- ions content in the leaf tissue. Finally, as a result SiO2 NPs and CS NPs are employed as part of a combined approach to increase the growth indices of citrus plants, especially achieving a significant impact in alleviating salinity stress.

Abstract Background With cancer cases escalation, an urgent request to develop novel combating strategies arise. Pathogen-based cancer-immunotherapy is getting more consideration. Autoclaved parasitic antigens seem promising candidates, taking steadily their first steps. Our aim was to examine the prophylactic antineoplastic activity of autoclaved Toxoplasma vaccine (ATV) and to test for the shared antigen theory between Toxoplasma gondii and cancer cells. Methods Mice were immunized with ATV followed by Ehrlich solid carcinoma (ESC) inoculation. Tumor weight, volume, histopathology, and immunohistochemistry for CD8+ T cells, Treg cells and VEGF were assessed. In addition, the proposed shared antigen theory between parasites and cancer was also verified using SDS-PAGE and immunoblotting. Results Results revealed powerful prophylactic activity of ATV with 13.3% inhibition of ESC incidence, significant reduction in tumor weight and volume in ATV vaccinated mice. Immunologically, significantly higher CD8+T cells and lower FOXP3+ Treg cells surrounded and infiltrated ESC in ATV immunized mice with higher CD8+T/Treg cells ratio and significant antiangiogenic effect. Moreover, SDS-PAGE and immunoblotting showed four shared bands between Ehrlich carcinoma and ATV of approximate molecular weights 60, 26, 22 and 12.5 KDa. Conclusion Exclusively, we demonstrated a prophylactic antineoplastic activity of autoclaved Toxoplasma vaccine against ESC. Moreover, to the best of our knowledge this is the first report highlighting the existence of cross-reactive antigens between Toxoplasma gondi parasite and cancer cells of Ehrlich carcinoma.

Abstract Despite the high antioxidant and penetration ability of pomegranate seed oil (PSO), the in vivo antitumor activity of PSO nano-emulsion has not been well investigated. Therefore, this study was undertaken to estimate the antitumor activity and safety of PSO nano-emulsion in mice bearing Ehrlich solid carcinoma cells. For tumor inoculation, about 2 × 106 viable Ehrlich tumor cells (200 µl) were implanted intramuscularly in the left thigh of hind leg. Once a solid tumor appears on the 10th day of transplantation; the mice were randomly divided into five groups (5 animals/group). Characterization of the PSO nano-emulsion using a Zeta sizer Malvern instrument and transmission electron microscope (TEM) revealed that the PSO nano-droplets were well dispersed with an average particle size of 8.95 nm and a spherical shape. Treatment with PSO nano-emulsions caused a significant reduction in the tumor size and weight, in a dose dependent manner, compared to tumor control group. Marked dose dependent elevations in the DNA damage level together with significant increases in the tumor suppressor p53, Bax and Caspase genes and reductions in the anti-apoptotic Bcl2 gene were also observed in the tumor tissue of mice given PSO nano-emulsions. Histological examination also revealed apoptosis and necrosis of tumor cells and tumor infiltration with inflammatory cells after PSO nano-emulsion treatment. However, high DNA damage was noticed in the liver and kidney tissues of mice given the highest dose of PSO nano-emulsion (400 mg/kg). Therefore, we concluded that PSO nano-emulsion exhibited a potent antitumor activity through induction of DNA breaks that triggers apoptosis of tumor cells but the highest dose caused genotoxicity to liver and kidney tissues, thus it is recommended to use doses lower than 400 mg/kg of PSO nano-emulsion as an alternative drugs for chemotherapy.

Abstract The Egyptian spiny mouse, Acomys cahirinus, is a recently described model organism for regeneration studies. It has surprising powers of regeneration with relatively fast repairing mechanisms and reduced inflammation form compared to other mammals. Although several studies have documented the exceptional capabilities of Acomys to regenerate different tissues after injury, its response to different cellular and genetic stresses is not yet investigated. Therefore, the current study aimed to investigate Acomys abilities to resist genotoxicity, oxidative stress and inflammation induced by acute and subacute treatments with lead acetate. Responses of Acomys were compared with those of the lab mouse (Mus musculus), which displays signatures of the “typical” mammalian response to various stressors. Cellular and genetic stresses were induced by using acute and subacute doses of Lead acetate (400 mg/kg and 50 mg/kg for 5 days, respectively). The assessment of genotoxicity was carried out by using comet assay, while oxidative stress was evaluated by measuring the biomarkers; MDA, GSH and antioxidant enzymes CAT and SOD. Moreover, inflammation was assessed by analyzing the expression of some inflammatory-regeneration-related genes: CXCL1, IL1-β, and Notch 2 and immunohistochemical staining of TNF-α protein in brain tissue, in addition to histopathological examination of brain, liver, and kidneys. The obtained results revealed a unique resistance potency of Acomys to genotoxicity, oxidative stress, and inflammation in certain tissues in comparison to Mus. Altogether, the results revealed an adaptive and protective response to cellular and genetic stresses in Acomys.

Objective Despite the application of aseptic protocols and the technical improvements of intraocular surgery, acute endophthalmitis is still noticed after cataract surgery. Presurgical prophylaxis was suggested to reduce the incidence of postcataract endophthalmitis. However, there is no clear protocol to follow. Aim The current study aimed to investigate the effect of preoperative topical antibiotics on anterior segment contamination in patients with cataract after phacoemulsification or phacotrabeculectomy. Patients, methods, and analysis The study enrolled 55 patients who underwent phacoemulsification or phacotrabeculectomy and intraocular lens implantation; 28 patients have used preoperative antibiotic drops (moxifloxacin 0.3%), and 27 patients did not use antibiotics. Anterior chamber (AC) aspirates were collected to determine the anterior segment microbial profile using microscopic examination and microbial cultures. Results All AC aspirates (100%) of the first group did not show any microbial growth on any culture media. However, bacterial growth was noted in three (11.1%) aspirates of the second group when cultured on blood, chocolate agar, and thioglycolate broth. Microscopic examination revealed Klebsiella pneumoniae, Escherichia coli, and Bacillus subtilis. All aspirates did not show any growth on Sabouraud dextrose agar. All patients were followed up after 1 day, 1 week, 1 month, and 3 months. Their ophthalmologic examinations were free of any abnormities. Conclusion Despite taking all the precautionary measures dictated by best practice guidelines for cataract surgery, there is minimal risk of AC bacterial contamination. Thus, the application of preoperative topical antibiotic drops is recommended for all cases.

This work aimed to develop and produce lacosamide-loaded niosomes coated with chitosan (LCA-CTS-NSM) using a thin-film hydration method and the Box-Behnken design. The effect of three independent factors (Span 60 amount, chitosan concentration, and cholesterol amount) on vesicle size, entrapment efficiency, zeta potential, and cumulative release (8 h) was studied. The optimal formulation of LCA-CTS-NSM was chosen from the design space and assessed for morphology, in vitro release, nasal diffusion, stability, tolerability, and in vivo biodistribution for brain targeting after intranasal delivery. The vesicle size, entrapment, surface charge, and in vitro release of the optimal formula were found to be 194.3 nm, 58.3%, +35.6 mV, and 81.3%, respectively. Besides, it exhibits sustained release behavior, enhanced nasal diffusion, and improved physical stability. Histopathological testing revealed no evidence of toxicity or structural damage to the nasal mucosa. It demonstrated significantly more brain distribution than the drug solution. Overall, the data is encouraging since it points to the potential for non-invasive intranasal administration of LCA as an alternative to oral or parenteral routes.

Abstract- Coronavirus 2019 spreads rapidly worldwide causing a global epidemic. Early detection and diagnosis of COVID-19 is critical for treatment as it causes respiratory syndrome appears in the chest medical images, such as computed tomography (CT) images, and X-ray images. The CT images are more sensitive and have more details compared to the X-ray images. Thus, automated segmentation plays an imperative role in detecting, diagnosing, and determining the spreading of COVID-19. In this paper, the DeepLabV3+ combined with MobileNet-V2 model was implemented. To validate this combination, we conducted a comparative study between the DeepLabV3+ variants by its combination with MobileNet-V2 against DeepLabV3+ combined with different CNN, namely ResNet-18, and ResNet50. Also, a comparative study with the basic traditional U-Net and modified Alex for segmentation was carried out. The experimental results showed the superiority of the using DeepLabV3+ combined with MobileNet-V2 for COVID-19 segmentation by achieving 97.5% mean accuracy, 95.2% sensitivity, 99.7% specificity, 99.7% precision, 99.3 % weighted Jaccard coefficient, and 97.5% weighted dice coefficient.

Abstract Turkevich gold nanospheres are the original nanospheres that have been modified over time. Its combination with targeting medications such as alendronate, memantine, and tobramycin will provide additional benefits in targeting specific areas in the bone, brain, and microorganisms, respectively. Hence, The reactivity and stability of nanospheres with various drug concentrations (milli-,micro-, and nano-levels) have been studied. With alendronate, the absorbance spectra of nanospheres at $$\uplambda _{max}$$ λ max 520 nm were always stable and no redshifts occurred. In contrast, the spectra with memantine and tobramycin were stable at the nano-level and redshifts occurred at the milli- and micro-levels. HRTEM and DLS revealed that the core diameter was relatively stable in all cases, whereas the hydrodynamic diameter and zeta potential varied with varying drug concentrations. Increasing concentration increased hydrodynamic diameter slightly with memantine (from 64.99 to 98.41 nm), dramatically with tobramycin (from 135.3 to 332.16 nm), and almost negligibly with alendronate (from 52.08 to 58.94 nm ). Zeta Potential, conversely, is reduced as concentration increases. Memantine had the greatest reduction in negativity, followed by tobramycin, but alendronate had a slight increase in negativity. Benefits from this research would be in targeted drug delivery, where stability and reactivity of gold nanospheres are critical.

Abstract Background We aimed to provide a consensus, evidence-based recommendations for the diagnosis, evaluation, and treat-to-target management of children living with FMF. This study was carried out to achieve an expert consensus on a treat-to-target management strategy for FMF using the Delphi technique. The preliminary scientific committee identified a total of 17 key clinical questions according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) approach. An evidence-based, systematic, literature review was conducted to compile evidence for the benefits and harms associated with JIA treatments. The core leadership team identified researchers and clinicians with expertise in FMF management. Delphi process was implemented (2 rounds) to reach a consensus on the management recommendations of FMF patients. Results Twenty-one expert panel participated in the 2 rounds with a response rate of 100%. A total of 12 recommendations, categorized into 2 sections (4 in the diagnosis section and 8 in management), were obtained. The agreement with the recommendations (rank 7–9) ranged from 85.7 to 100%. The consensus was reached (i.e., ≥75% of respondents strongly agreed or agreed) on all the clinical standards. Algorithms for management have been also developed. Conclusion A wide and representative panel of experts established a consensus regarding the management of FMF. The developed guidelines provide a comprehensive treat-to-target approach to the management of FMF for all healthcare professionals who are involved in its management.

Abstract Background Macrophage activation syndrome (MAS) is a severe life-threatening hyperinflammatory state with uncontrolled activation and proliferation of macrophages and T-lymphocytes. MAS has variable causes and risk factors. Early diagnosis and optimum management could be lifesaving. Our aim was to develop a consensus, evidence-based recommendations for the diagnosis, evaluation, and treat-to-target management of pediatric MAS. This study was carried out to achieve an Egyptian expert consensus on a treat-to-target management strategy for MAS using the Delphi technique. The multistep process strategy was used in developing a consensus, evidence-based treatment guidelines for MAS, started by developing 7 key clinical questions by a scientific committee according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) approach. The core leadership team identified pediatric rheumatology clinicians and researchers throughout Egypt. To generate evidence for MAS management, an evidence-based, systematic literature review was done. To obtain a consensus, the Delphi procedure (3 rounds) was used. Results Twenty-three expert panel participated in the 3 rounds with a response rate of 100%. A total of 19 recommendations, categorized into 2 sections (11 in the diagnosis section and 8 in management), were obtained. The agreement with the recommendations (ranks 7–9) ranged from 86.9 to 95.7%. The consensus was reached (i.e., ≥75% of respondents strongly agreed or agreed) on all the clinical standards. Algorithms for management have been also developed. Conclusion This was an expert, consensus recommendation for the diagnosis and treat to target of MAS, based on the best available evidence and expert opinion. The guidelines fill a gap in the literature as it presents a T2T approach for MAS.

Abstract Background These updated guidelines aimed to provide appropriate and convenient guidelines for the treatment of various types of juvenile idiopathic arthritis (JIA). Using the Delphi technique, this study was conducted to reach expert consensus on a treat-to-target management strategy for JIA. According to the PICO (patient/population, intervention, comparison, and outcomes) approach, the preliminary scientific committee identified a total of 17 key clinical questions. To assemble evidence on the advantages and dangers associated with JIA treatments, an evidence-based, systematic literature review was conducted. Researchers and clinicians with experience in JIA management were identified by the core leadership team. To establish a consensus on the management suggestions for JIA patients, a Delphi approach (2 rounds) was used. Results An online survey was applied to the expert panel (n = 27), and 26 of them completed both rounds. At the conclusion of round 2, a total of eighteen (18) recommendation items were gathered, which were divided into four sections to address the four key JIA categories. The percentage of those who agreed with the recommendations (ranks 7–9) ranged from 83.2 to 100% (average 86.8%). The phrasing of all 18 clinical standards identified by the scientific committee was agreed upon (i.e. 75% of respondents strongly agreed or agreed). Algorithms have been proposed for the management of JIA polyarthritis, oligoarthritis, and systemic JIA. Conclusion A wide and representative panel of experts initiated a consensus about the management of JIA. The created guidelines give a complete approach to the management of JIA for all healthcare professionals involved in its management, as well as a means of monitoring and evaluating these guidelines on a regular basis.

Abstract Purpose To evaluate the efficacy of single intravitreal injection of an expansile concentration of sulphur hexafluoride gas (SF6) in treating patients with symptomatic focal vitreomacular traction (VMT) documented by spectral domain optical coherence tomography (SD-OCT) preoperatively. Methods This is a prospective interventional case series including 30 eyes of 29 patients with symptomatic focal VMT evident on SD-OCT. Pre-operatively, mean best corrected visual acuity (BCVA) was 20/125 (range 20/400–20/40). Mean central foveal thickness (CFT) was 382 μm (range 149–576 μm; SD ± 91.88). All eyes received single intravitreal injection of 0.3 mL of 100% SF6 gas. Postoperatively, we performed SD-OCT at one week, one month, and three months for all eyes. Primary outcome measure was release of VMT. Secondary outcome measures were changes in postoperative BCVA andCFT. Results Overall, VMT release occurred in 24 of 30 eyes by the final follow-up visit (80% final release rate); furthermore, 76.9% of eyes with diabetic maculopathy and 25% of eyes with concurrent epiretinal membrane (ERM) had successful VMT release. VMT release was documented on SD-OCT at an average of 3 weeks (range, 1–12 weeks). The rate of release in phakic eyes was 90% (18 of 20 eyes) versus 60% in pseudophakic eyes (6 of 10 eyes). One patient developed a retinal break at upper nasal retina after two weeks of injection. Conclusion Pneumatic vitreolysis (PVL) with limited face-down position is a viable option for treating focal VMT with few adverse events. Further studies are needed to evaluate its indications, benefits, and risks.

Background Teeth loss results in significant complications that can severally affect the individuals’ general health and social activities. Several studies have documented the association between socioeconomic issues and the prevalence of oral diseases and prosthetic rehabilitation. Thus, this study aimed to explore the impact of socioeconomic factors on prosthetic rehabilitation modalities in a sample of adult urban and rural Egyptian populations. Patients and methods A total of 400 adults of age over 18 years were included in this study. Half of them were from urban governorates (Cairo and Giza). And the other half were from the rural governorate (Al-Fayoum). Information concerning demographic (sex and age) and socioeconomic (education level, occupation, and income) factors were collected using the modified WHO questionnaire. In addition, prosthetic rehabilitation status was evaluated through intraoral examination. Results The percentage of female participants was higher than males in both urban and rural regions. The age range for more than two-thirds of the participants was from 30 to 60 years. In urban areas, about 39% of participants were completely dentulous, 34.5% were partially edentulous without prosthetic rehabilitation, and only 26.5% made dental prostheses. Regarding rural participants, about 35% of them were completely dentulous, 64.5% partially edentulous without prosthetic treatment, and only 0.05% received prosthesis. Comparison between the urban and rural dentition status and rehabilitation modalities showed a statistically significant difference (P

Objectives: The aim of this in vitro study was to evaluate the effect of NaF plus TCP with and without CO2 laser irradiation on management of demineralized enamel using microhardness test and digital microscopy. Methods: Eighty intact extracted human premolar teeth were randomly divided into 4 groups (20/each). Each group was subjected to a demineralizing solution to create white spot lesion. Group 1 was treated with 3M Vanish™. Group 2 was irradiated with CO2 laser. Group 3 was subjected to CO2 laser followed by 3M Vanish™. Group 4 was treated by 3M Vanish™ then CO2 laser. The teeth were immersed in artificial saliva. Surface microhardness was measured for each tooth before demineralization at base line (M1 as a control), after demineralization (M2) and after management (M3). Comparison of microhardness values between groups was performed using one way ANOVA test with significant level (0.05) followed by multiple comparisons post-hoc Tukey test between groups. Enamel surface was photographed by digital microscope. Results: All intervention methods used in the current study significantly increased microhardness values of demineralized enamel (P < 0.001). Little improvement of enamel appearance was observed in all groups meanwhile using CO2 laser on demineralized enamel directly led to signs of white and black dots affecting the appearance of enamel surface. Significance: The most effective intervention regarding microhardness was group 2 followed by group 3, group 4 and group 1. Coating the enamel surface with 3M Vanish™ before CO2 laser irradiation acted as a protective layer from the undesirable effects of laser on the teeth with increasing enamel microhardness values more than using Vanish alone. So the promising intervention method regarding both microhardness and appearance was group 4.

Background: Post-surgical pain is a challenging problem. Different modifications of surgical procedures and use of different analgesics had been reported. However, no consensus had been reached for post-surgical pain control. Tonsillectomy is one of the most commonly performed surgical procedure and pain control still controversial. Aim of the work:To investigation safety and efficacy of intravenous paracetamol, ibuprofen, or both for post-tonsillectomy pain control. Patients and Methods:The study had been carried at Otorhinolaryngology and Eye, Al-Jabr hospital,Anesthesia and Intensive Care Department in collaboration with Otorhinolaryngology department and the day care surgery unit], Al-Ahasa directorate, Kingdom of Saudi Arabia [KSA]. It included children aged 2 to 10 years. Patients had been randomly allocated into 3 equal groups [each 30 patients]. Group A [intravenous paracetamol 15mg/kg], Group B [intravenous ibuprofen 10mg/kg], and Group C [intravenous paracetamol 7.5 mg/kg and ibuprofen 5mg/kg]. The examined drug had been administrated 20 minutes after induction of general anesthesia. The analgesic effects and hemodynamics had been assessed on regular postoperative intervals till patient discharge, and patient satisfaction had been addressed. Any side effects and need for postoperative analgesia had been documented. Results: Studied groups were comparable regarding patient demographics, recovery time, hospital stay duration and need for additional analgesia. However, pain was significantly variable between studied groups till 3 hours postoperatively. Pain was significantly reduced at groups B [IV ibuprofen] and C [IV paracetamol and Ibuprofen with reduced dose] when compared to group A [IV paracetamol] at all times. In addition, hemodynamic variability was observed for mean arterial pressure and heart rate. At five minutes, blood pressure was significantly higher in group B when compared to group C, and at 5 minutes to 2.5 hours, it was significantly increased among group A when compared to group C. Conclusion: Drug combination with reduced [half the dose] of both intravenous paracetamol and ibuprofen is more effective and safer than single drug with higher dose. The studied drugs avoid the well-known side effects of opioids.

Abstract Background The control of schistosomiasis has been centered to date on a single drug, praziquantel, with shortcomings including treatment failure, reinfection, and emergence of drug resistance. Drug repurposing, combination therapy or nanotechnology were explored to improve antischistosomal treatment. The aim of the present study was to utilize a novel combination of the three strategies to improve the therapeutic profile of praziquantel. This was based on a fixed-dose nanocombination of praziquantel and miltefosine, an antischistosomal repurposing candidate, co-loaded at reduced doses into lipid nanocapsules, for single dose oral therapy. Methods Two nanocombinations were prepared to provide 250 mg praziquantel-20 mg miltefosine/kg (higher fixed-dose) or 125 mg praziquantel-10 mg miltefosine/kg (lower fixed-dose), respectively. Their antischistosomal efficacy in comparison with a non-treated control and their praziquantel or miltefosine singly loaded counterparts was assessed in murine schistosomiasis mansoni. A single oral dose of either formulation was administered on the initial day of infection, and on days 21 and 42 post-infection. Scanning electron microscopic, parasitological, and histopathological studies were used for assessment. Preclinical data were subjected to analysis of variance and Tukeyʼs post-hoc test for pairwise comparisons. Results Lipid nanocapsules (~ 58 nm) showed high entrapment efficiency of both drugs (> 97%). Compared to singly loaded praziquantel-lipid nanocapsules, the higher nanocombination dose showed a significant increase in antischistosomal efficacy in terms of statistically significant decrease in mean worm burden, particularly against invasive and juvenile worms, and amelioration of hepatic granulomas (P ≤ 0.05). In addition, scanning electron microscopy examination showed extensive dorsal tegumental damage with noticeable deposition of nanostructures. Conclusions The therapeutic profile of praziquantel could be improved by a novel multiple approach integrating drug repurposing, combination therapy and nanotechnology. Multistage activity and amelioration of liver pathology could be achieved by a new praziquantel-miltefosine fixed-dose nanocombination providing 250 mg praziquantel-20 mg miltefosine/kg. To the best of our knowledge, this is the first report of a fixed-dose nano-based combinatorial therapy for schistosomiasis mansoni. Further studies are needed to document the nanocombination safety and explore its prophylactic activity and potential to hinder the onset of resistance to the drug components.

Abstract Background Stigma is a basic component of the negative discrimination that people with mental illness experience every day. It blocks access to facilities that have been created to help people with mental illness. Furthermore, the attitudes held by people with authority (including clinical staff and officers) towards people with mental illness are likely to influence their attitude towards them and hence the experience and treatment outcome of the patients. The aim of this work is to study and compare the attitudes of Egyptian residents of different clinical specialties and house officers towards patients with mental illness. The current study aimed to study the attitudes of Egyptian medical residents and house officers towards patients with mental illness and compare between both groups. This cross-sectional comparative study was designed to assess 150 residents and 201 house officers at Ain Shams University Hospitals by using the Mental Illness Clinician Attitude Scale version 4 (MICA-4) and newly designed questions related to stigma. Results The study revealed that the scores of MICA questionnaire were significantly lower than the cut point for negative attitude in both residents and house officers (P

AIM: To assess the changes in the anterior chamber parameters using Pentacam following four different lines of treatment of primary angle-closure glaucoma (PACG). METHODS: A retrospective comparative study included 126 patients (126 eye) presented within 24-48h after acute angle-closure glaucoma (AACG). Patients were divided into 2 groups: group A (68 eyes) with controlled intraocular pressure (IOP) ≤21 mm Hg, which included subgroup A1 (34 eyes) with clear lens underwent Nd:YAG laser peripheral iridotomy (LPI) and subgroup A2 (34 eyes) with cataract underwent standard phacoemulsification; and group B (58 eyes) with uncontrolled IOP, which included subgroup B1 (30 eyes) with clear lens underwent trabeculectomy and subgroup B2 (28 eyes) with cataract underwent combined phacoemulsification and trabeculectomy. Patients were followed up for at least 3mo. Primary outcomes were Pentacam anterior segment measurements [anterior chamber angle (ACA) and depth (ACD)]. Secondary outcomes were changes in IOP, visual acuity (VA) and recorded complications. RESULTS: At the 3rd month, there was significant increase in the ACA values in all studied groups compared to preoperative values (P

Introduction Mental disorders in Europe represent the leading cause of disability and the third leading cause of overall disease burden, following cardiovascular disease and cancers. As future healthcare professionals, with an imminent role in tackling this global health issue, we acknowledge that Mental Health is not adequately included in the medical curriculum. To address this gap, this workshop was created to equip medical students with the knowledge and skills that will empower them to lead a pioneering role in advocating for mental health for their patients, peers, and communities. Objectives By the end of the workshop, all participants should have: - Increased their knowledge in the field of Mental Health disorders - Increased their skills in the field of Mental Health (preventive practices, intervention strategies towards others, etc.) - Explored the relations between stigma, vulnerability, and Mental Health - Strengthened the international perspective and global understanding concerning mental health issues Methods This workshop utilized principles of non-formal education and was planned according to the 4MAT system to meet all four learning styles through theory blocks, space for reflection, practical application of knowledge, and future opportunities for application of content. This was achieved through various methodologies including presentations, self-discovery activities and exercises, roundtable debates, simulations, and role-playing. Results obtained Conclusions This workshop highlighted the importance of building the capacity of medical students to tackle the burden of Mental Health globally and within the region, and how similar student-led initiatives can further empower them to be change agents and impactful advocates for better Mental Health in their own communities.

Abstract This paper deals with on line viscosity measurements using integrated circuit technology, and is building on a previous paper on the use radio frequency identifier (RFID) technology for determining dielectric coefficients. It is asserted that the progress in RFID technology and integrated circuits, in particular in micro–electro–mechanical system (MEMS) makes it possible to combine them to perform physico-chemical property measurements using devices on centimeter scale. It can even be expected that these devices can be made increasingly smaller. An important property of interest is the viscosity, in this specific case, for the use of Arabic gum in enhanced oil recovery. Arabic gum, is an environmentally acceptable natural product. Natural-polymer solutions 1000 [ppm] are more viscous and therefore more efficient oil displacement agents. They require less invested exergy than non-viscosified water to recover oil. However, polymers, in particular environmentally acceptable natural-polymers (e.g., Guar–Arabic gum) available in large quantities in India and Sudan, are susceptible to microbial degradation. It is therefore important to monitor its quality at the injection and production side for real-time quality control. Natural-polymers based on plant products are promising EOR agents. They may have a lower environmental footprint because of the biodegradability. To provide a proof of concept, we use a state of the art acoustic wave sensor (AWS), which can determine acoustic viscosities. It is asserted that RFID technology can be used to record the acoustic wave signal (SenGenuity vismart acoustic wave Sensor AWS) to determine the viscosity at some distance (meters) away from the measurement device. A calibration with solutions of known viscosity behavior (i.e., Glycerol) can be used to relate the acoustic viscosity to the dynamic viscosity. We can calibrate the acoustic wave sensor using Guar–Arabic gum solutions to measurements with the Anton Paar viscometer (MCR-302). For the glycerol solution we also compare to reported literature data. The Newtonian viscosity measurements of the Paar density meter, and the literature values agree within a few percent. These favorable comparisons, are an important step in developing a methodology that allows cutting edge RFID-IC technology for real-time non-contact monitoring of viscosity degradation.

This research aimed to boost granisetron (GS) delivery to the brain via the intranasal route to better manage chemotherapy-induced emesis. Glycerol monooleate (GMO), Poloxamer 407 (P 407) and Tween 80 (T 80) were used to formulate GS-loaded cubosomes (GS-CBS) utilizing a melt dispersion-emulsification technique. GS-CBS were characterized by testing particle diameter, surface charge and entrapment efficiency. The formulations were optimized using a Box–Behnken statistical design, and the optimum formula (including GMO with a concentration of 4.9%, P 407 with a concentration of 10%, and T 80 with a concentration of 1%) was investigated for morphology, release behavior, ex vivo permeation through the nasal mucosa, and physical stability. Moreover, the optimal formula was incorporated into a thermosensitive gel and subjected to histopathological and in vivo biodistribution experiments. It demonstrated sustained release characteristics, increased ex vivo permeability and improved physical stability. Moreover, the cubosomal in situ gel was safe and biocompatible when applied to the nasal mucosa. Furthermore, compared to a drug solution, the nose-to-brain pathway enhanced bioavailability and brain distribution. Finally, the cubosomal in situ gel may be a potential nanocarrier for GS delivery to the brain through nose-to-brain pathway.

Rheumatoid arthritis (RA) is a chronic inflammatory illness affecting the joints. The characteristic of RA is gradual joint deterioration. Current RA treatment alleviates signs such as inflammation and pain and substantially slows the progression of the disease. In this study, we aimed to boost the transdermal delivery of berberine (a natural product) by encapsulating it in chitosan, surface-modified bilosomes nanogel for better management of the inflammation of RA. The chitosan-coated bilosomes loaded with berberine (BER-CTS-BLS) were formulated according to the thin-film hydration approach and optimized for various causal variables, considering the effect of lipid, sodium deoxycholate, and chitosan concentrations on the size of the particles, entrapment, and the surface charge. The optimized BER-CTS-BLS has 202.3 nm mean diameter, 83.8% entrapment, and 30.8 mV surface charge. The optimized BER-CTS-BLS exhibited a delayed-release profile in vitro and increased skin permeability ex vivo. Additionally, histological examination revealed that the formulated BLS had no irritating effects on the skin. Furthermore, the optimized BER-CTS-BLS ability to reduce inflammation was evaluated in rats with carrageenan-induced paw edema. Our results demonstrate that the group treated with topical BER-CTS-BLS gel exhibited a dramatic reduction in rat paw edema swelling percentage to reach 24.4% after 12 h, which was substantially lower than other groups. Collectively, chitosan-coated bilosomes containing berberine have emerged as a promising therapeutic approach to control RA inflammation.

Abstract: Outcomes of hematopoietic stem cell transplantation (HSCT) have markedly improved over the past 2 decades, underscoring a need to better understand the long-term health effects of this intensive treatment modality. We describe the burden of chronic medical conditions and frail health among St. Jude Lifetime Cohort Study participants treated for childhood hematologic malignancies with HSCT (n = 112) or with conventional therapy (n = 1106). Chronic conditions and frail health were ascertained clinically and classified according to a modified version of the Common Terminology Criteria for Adverse Events (version 4.03) and the Fried Frailty Criteria. Seventy-nine transplants were allogeneic (41 from a sibling donor, 34 unrelated, and 4 others from related donor). Twenty-five allogeneic donor recipients had a history of chronic graft-versus-host disease. Compared to those treated with conventional therapy, a higher percentage of HSCT survivors had severe, disabling, or life threatening (grade 3-4) chronic conditions (81.3% vs 69.2%, P= .007). By age 25 years, HSCT survivors experienced 148 grade 3-4 events/100 compared to 60 among conventional therapy survivors (P≮ .001). Percentages of survivors with second neoplasms (17.0% vs 7.9%, P= .003), grade 3-4 cardiovascular (19.6% vs 10.2%, P= .004) and pulmonary (16.1% vs 4.6%, P≮ .001) conditions, and frail health (7.1% vs 1.6%, P≮ .001) were higher after HSCT than conventional therapy. These results underscore the need for clinical follow-up and provide data to guide the development of prevention and/or intervention strategies for this vulnerable population.

Challenges facing power system protection in a wide-area system are latency and full coverage of a wide-area disturbance. The complexity of large-scale power system configurations has led to challenges in the design of coordination and operating systems for protection relays. Local measurements used for primary and backup protection cannot consider wide system disturbances. A new wide-area-monitoring-system-based primary protection is presented for a complex power system involving double and single lines. It is based on describing the non-linear dynamic operation of the transmission lines during a fault in the form of a set of differential equations that are solved through paths movements in a phase diagram. The fault on the lines can be precisely recognised. The speed of the traditional communication media limits wide-area monitoring as backup protection. This study presents the primary protection scheme for double and single circuits in a wide area for the first time based on fourth-generation technology with low latency. The justification for applying the proposed scheme as primary protection in a wide-area-monitoring system is discussed. The number of relays on the studied configuration is reduced from 18 local relays to only 5 phasor measurement units for protecting the lines in the area.