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Abstract Background Pulmonary hypertension (PH) represents a condition affecting small arteries of the pulmonary vasculature, inducing progressive blockage that results in increased pulmonary vascular resistance (PVR) as well as pulmonary arterial pressure (PAP), which are defining features of such a disorder. This work was aimed at investigating the PH prevalence among chronic kidney disease (CKD) cases and its linkage to disease severity and the relations between CKD management and PH. Methods Our prospective observational descriptive cross-sectional study was conducted on 120 CKD patients at the Chest Department, Tanta University Hospitals and Air Forces Specialized Hospitals from December 2020 to December 2022. Results The most frequent diagnosis of PH was Group 1 pulmonary arterial hypertension (36.7%) followed by Group 2 cardiac causes (30%) followed by Group 4 chronic thromboembolic PH (26.7%) and (6.7%) experienced normal pulmonary hemodynamics by RHC. Also, a statistically significant correlation was documented among CKD staging as well as risk assessment of PH (p 0.024). A significant association was documented among treatment as well as risks for developing PH (p 0.034). Patients on medical treatment (60%) showed low risk while (33.3%) of patients depending on dialysis showed high risk. Conclusions PH was diagnosed in 28 CKD patients confirmed by right (RT) side cardiac catheterization among 120 CKD patients studied for PH assessment representing 23.5%. Right-side cardiac catheterization is more accurate than echocardiography in confirming the diagnosis of PH. The severity of PH showed significant association with the CKD stage.

This paper introduces a novel approach to image denoising that leverages the advantages of Generative Adversarial Networks (GANs). Specifically, we propose a model that combines elements of the Pix2Pix model and the Wasserstein GAN (WGAN) with Gradient Penalty (WGAN-GP). This hybrid framework seeks to capitalize on the denoising capabilities of conditional GANs, as demonstrated in the Pix2Pix model, while mitigating the need for an exhaustive search for optimal hyperparameters that could potentially ruin the stability of the learning process. In the proposed method, the GAN’s generator is employed to produce denoised images, harnessing the power of a conditional GAN for noise reduction. Simultaneously, the implementation of the Lipschitz continuity constraint during updates, as featured in WGAN-GP, aids in reducing susceptibility to mode collapse. This innovative design allows the proposed model to benefit from the strong points of both Pix2Pix and WGAN-GP, generating superior denoising results while ensuring training stability. Drawing on previous work on image-to-image translation and GAN stabilization techniques, the proposed research highlights the potential of GANs as a general-purpose solution for denoising. The paper details the development and testing of this model, showcasing its effectiveness through numerical experiments. The dataset was created by adding synthetic noise to clean images. Numerical results based on real-world dataset validation underscore the efficacy of this approach in image-denoising tasks, exhibiting significant enhancements over traditional techniques. Notably, the proposed model demonstrates strong generalization capabilities, performing effectively even when trained with synthetic noise.

Background : Obesity-induced dyslipidemia is one of the main factors contributing to morbidity and mortality associated with metabolic syndrome, atherosclerosis, and coronary artery disease among patients with systemic lupus erythematosus (SLE). Objectives: This research aimed to assess the effect of adding laser acupuncture therapy (LAT) to a Pilates exercise program (PEP) and low-calorie diet protocol (LCDP) on blood lipids among 60 obese women with SLE. Methods : Study participants were women aged between 23 and 49 years, randomly assigned to one of two groups, A or B, each comprising 30 women. In addition to adherence to the LCDP, both groups were supervised five times weekly during 50-minute PEP sessions. Group A also received LAT three times weekly, with each session lasting 2 minutes on selected acupoints. After the 12-week intervention, plasma total cholesterol, high-density lipoprotein, triglycerides, and low-density lipoprotein were assessed. Results : Both groups demonstrated significant improvement in the aforementioned lipids after the 12-week intervention. A comparison between the post-intervention values of the lipids in the groups revealed a significant improvement favoring group A (the group that received LAT). Conclusion : Adding a 12-week LAT regimen to PEP and LCDP significantly improved lipid profiles among 60 obese women with SLE.

Background. Having an estimated level of Hb drop in different orthopedic surgeries would help plan for surgery from pre- to postoperative periods. The aim of this study was to assess the Hb drop and the associated factors during the intraoperative period among elective orthopedic surgeries. Methods. This was an analytic cross-sectional study conducted between October 2022 and March 2023, which included all patients admitted for elective orthopedic surgery who met the inclusion criteria. Data were collected before and after the patient was operated on. Information was analyzed using t-tests and ANOVA to establish the statistical significance of the Hb drop. Results. A total of 195 participants were enrolled. The majority of the participants were male (62.1%), with the main etiology of symptoms being motor traffic accidents (31.8%). The most affected site was the femur (36.4%), followed by the spine (23.6%). The highest mean Hb drop was in total hip replacement surgeries (4.19 g/dL), with the overall mean Hb drop being 2.75 g/dL. A statistically significant difference was identified in diathermy use, duration of surgery, and patients with chronic illnesses. Conclusion. With a mean Hb drop of 2.75 g/dL, the application of diathermy and surgeries with shorter durations resulted in a reduced Hb drop. These factors should be incorporated to minimize the drop in Hb in orthopedic surgeries. Accounting for differences in surgeries, there should not be delays in patients who have a preoperative Hb level that can sustain the mean Hb drop recorded in the study.

Abstract African children are at risk of malaria and malnutrition. We quantified relationships between malaria and malnutrition among young Ugandan children in a high malaria transmission region. Data were used from a randomized controlled trial where Ugandan HIV‐unexposed (n = 393) and HIV‐exposed (n = 186) children were randomized to receive no malaria chemoprevention, monthly sulfadoxine‐pyrimethamine, daily trimethoprim‐sulfamethoxazole, or monthly dihydroartemisinin‐piperaquine (DP) from age 6–24 months, and then were followed off chemoprevention until age 36 months. Monthly height and weight, and time of incident malaria episodes were obtained; 89 children who received DP contributed piperaquine (PQ) concentrations. Malaria hazard was modeled using parametric survival analysis adjusted for repeated events, and height and weight were modeled using a Brody growth model. Among 579 children, stunting (height‐for‐age z‐score [ZHA]

Introduction Chronic-plaque psoriasis is a chronic inflammatory dermatological disease. Obesity comorbidities, including non-alcoholic fatty liver disease, are highly prevalent in patients with chronic-plaque psoriasis. Recently, weight loss has been a highly recommended intervention to improve the severity of psoriatic symptoms, psoriasis-induced chronic systemic inflammation, psoriasis-associated cardiovascular risk factors, quality of life, and the efficacy of anti-psoriatic drugs. This study was designed to assess the effect of a 12-week low-calorie-diet intervention on aspartate transaminase, psoriasis severity (assessed via Psoriasis Area and Severity Index – PASI), alanine transaminase, quality of life (assessed via Dermatology Life Quality Index – DLQI), triglycerides, waist circumference (WC), and body mass index (BMI) in class I obese men with chronic-plaque and non-alcoholic fatty liver disease. Material and methods Sixty men with age ≥ 18 years with class I obesity and with chronic plaque psoriasis and non-alcoholic fatty liver disease were included in the study. All participants were randomly assigned to one of two groups: the first group as the low-calorie-diet group (30 men received immunosuppressive drugs, followed a low-calorie diet, and increased their energy expenditure through a daily 15,000-step outdoor walking program for 12 weeks) and the second as the control group (30 men received immunosuppressive drugs only). The primary outcome consisted of the results of the area and severity index. Weight, BMI, WC, laboratory results such as triglycerides, liver enzymes (alanine transaminase and aspartate transaminase) as well as DLQI were considered as secondary outcomes. Results While no significant improvements were achieved in the measured variables of the control group, the low-calorie-diet group demonstrated significant improvement in all the measured variables. Conclusions The results of the present study confirmed that 12-week low-calorie-diet intervention controls BMI, increases the response of psoriasis to pharmacological agents and improves the quality of life. Diet interventions significantly control the elevated hepatic enzymes (aspartate and alanine transaminases) and triglycerides in male patients with chronic-plaque psoriasis and non-alcoholic fatty liver dis-ease.

Background : Blood lipid levels have been reported as novel biomarkers for chronic subjective tinnitus (CST), with their levels being higher in patients with CST. Objectives: This trial aimed to determine the change in lipid profile and tinnitus-related quality of life (TR-QoL) responses to 8-week acupuncture treatment in patients with CST. Methods : Sixty obese patients with CST were randomly assigned to group A (treatment group; n = 30; mean age = 44.10 ± 3.69 years) or group B (sham group; n = 30; mean age = 45.53 ± 3.62 years). Patients in group A (n = 30) received manual stimulation at the TE3, TE5, TE17, TE18, TE19, TE20, TE21, TE22, GB2, GB8, GB20, LI4, LI11, KI3, SP6, ST36, CV4, CV9, and CV12 acupoints through in-site acupuncture needles thrice weekly. Furthermore, the bilateral abdominal ST25 and GB28 acupoints were electrically stimulated through in-site acupuncture needles. Group B (n = 30) received the same acupuncture protocol as group A but the insertion of needles was a sham insertion. Anthropometrics such as body mass index (BMI) and waist circumference (WC), TR-QoL (assessed via tinnitus handicap inventory), blood lipid levels such as high-density lipoprotein (HDLs), low-density lipoprotein (LDLs), cholesterol (C), and triglycerides (TGs), and the visual analogue scale (VAS) score for tinnitus severity, were assessed prospectively. Results : Only group A showed significant within-group improvements. Except for HDLs, BMI, and WC, unpaired between-group comparisons showed significantly greater improvements in other outcome measures of all patients with tinnitus (TR-QoL, LDLs, TGs, C, and VAS) in group A than in group B. Conclusion : Safe acupuncture treatment not only improves anthropometrics and TR-QoL, but also helps resolve hyperlipidemia and reduces the severity of tinnitus in obese patients with CST.

BackgroundMultidrug-resistant tuberculosis (MDR-TB) remains a public health emergency and a threat globally. Although increasing MDR-TB cases have been recently reported in Somalia, limited information is known. This study aims to determine the prevalence of drug-susceptible and MDR-TB in suspected patients referred to the TB Department in Mudug Hospital, Galkayo, Somalia, and identify potential factors associated with MDR-TB.MethodsA 3-year hospital laboratory-based retrospective study was conducted by manually reviewing laboratory records of Mycobacterium tuberculosis specimens and GeneXpert MTB/RIF results from January 2019 to December 2021 at the reference mycobacteria laboratory department in Mudug Hospital.ResultsA total of 714 positive GeneXpert-MTB results were identified: 619 (86.7%) were drug susceptible (no Rifampin resistance [RR] detected) and 95 (13.3%) with RR detected or defined as MDR-TB. Most of the MDR-TB patients were males (71.6%, 68/95) and between the ages of 15 to 24 (31.6%, 30/95). Most isolates were collected in 2021 (43.2%, 41/95). Multivariate analyses show no significant difference between patients having MDR-TB and/or drug-susceptible TB for all variables.ConclusionThis study showed an alarming frequency of MDR-TB cases among M. tuberculosis-positive patients at a regional TB reference laboratory in central Somalia.

Intermittent preventive treatment with dihydroartemisinin-piperaquine (DP) is protective in children against malaria. Here, the authors analyze plasma drug concentration, malaria incidence, and drug resistance markers from a clinical trial in Uganda and determine the optimal DP dosing regimen.

Background : Despite the adherence to medications, the control of the modifiable key risk factor—intraocular pressure (IOP)—for the progression of primary open-angle glaucoma (POAG) in diabetics is usually difficult; hence, many glaucoma patients try other alternative therapeutic options. Objectives: This randomized controlled study investigated the short-term IOP response to the combined effects of transcutaneous electrical nerve stimulation over acupoint (Acu-TENS) and yoga ocular exercise in type 2 diabetics with POAG. Methods : Eighty diabetics with bilateral POAG, ages ≥ 50 years, IOP > 21 mmHg in both eyes, and a body mass index below 30 kg/m2 were included in this trial. The patients were randomly assigned to group A (n = 40; this group received 20 minutes of yoga ocular exercise followed by 20 minutes of active Acu-TENS over bilateral BL 61 and BL 62 acupoints) and group B (n = 40; this group received the same protocol as group A but with a placebo Acu-TENS). The repeated measurement of IOP were recorded before, immediately after, 30 minutes, and 60 minutes after the sessions. Results : The repeated measures analysis of variance revealed a greater significant decline of IOP in group A than group B in both eyes at the consecutive intervals of time measurements. Conclusion : According to this short-term observation, the addition of Acu-TENS to yoga ocular exercise could reduce the high IOP in diabetic patients with POAG, but further longterm trials are needed.

A lot of time is spent on exercising the body parts while the lips are neglected, despite the evidence on the wide-ranging effects of lips on overall health and quality of life. Oral rehabilitation by Patakara lip muscle trainer leads to a strong lip closure which can stand as the first-line defense mechanism against many oral dysfunctions related to aging. In the absence of a narrative review presented on this trainer, this paper focuses on the components, instructions for use, and oral health indications of the Patakara lip muscle trainer. This trainer could enhance many oral dysfunctions in the elderly as oral breathing, snoring, halitosis, dry mouth, and oral/gastrointestinal dysfunction, but future studies are needed in this field.

Introduction: Malaria and soil-transmitted helminth (STH) co-infection is an important parasitic infection affecting populations in co-endemic countries including Equatorial Guinea. To date, the health impact of STH and malaria co-infection is inconclusive. The current study aimed to report the malaria and STH infection epidemiology in the continental region of Equatorial Guinea. Methods: We performed a cross-sectional study between October 2020 and January 2021 in the Bata district of Equatorial Guinea. Participants aged 1–9 years, 10–17 years and above 18 were recruited. Fresh venous blood was collected for malaria testing via mRDTs and light microscopy. Stool specimens were collected, and the Kato–Katz technique was used to detect the presence of Ascaris lumbricoides, Trichuris trichiura, hookworm spp. and intestinal Schistosoma eggs. Results: A total of 402 participants were included in this study. An amount of 44.3% of them lived in urban areas, and only 51.9% of them reported having bed nets. Malaria infections were detected in 34.8% of the participants, while 50% of malaria infections were reported in children aged 10–17 years. Females had a lower prevalence of malaria (28.8%) compared with males (41.7%). Children of 1–9 years carried more gametocytes compared with other age groups. An amount of 49.3% of the participants infected with T. trichiura had malaria parasites compared with those infected with A. lumbricoides (39.6%) or both (46.8%). Conclusions: The overlapping problem of STH and malaria is neglected in Bata. The current study forces the government and other stakeholders involved in the fight against malaria and STH to consider a combined control program strategy for both parasitic infections in Equatorial Guinea.

Many try to eat sustainably but reliable information is lacking, and environmental impact often prioritises over nutritional quality. Here we consider beneficial fatty acid profiles in steaks from 4 UK systems: non-organic, organic, certified pasture-fed and conservation cattle.Most individual fatty acids and ratios considered beneficial for health (individual and total omega 3, vaccenic acid and CLA) followed a gradient, against assumed intensity of production. Ratios for linoleic acid: α-linolenic acid, omega-6:omega-3 and SFA:PUFA in pasture-fed sirloins were only 27%, 55% and 70% (respectively) of those in non-organic beef. Intramuscular fat from pasture-fed meat had twice as much omega-3 and 1.9x the long chain omega-3 concentrations compared with non-organic meat, with a ratio of omega-6:omega-3 only 38% of that in non-organic meat.Meat from 100% pasture-fed and conservation grazing offer public good, matching dietary guidelines better than meat from mainstream systems and qualifying as a source of long chain omega-3 fatty acids.

Objective: The objective was to determine the predicting success of shock wave lithotripsy (SWL) using a combination of computed tomography based metric parameters to improve the treatment plan. Patients and Methods: Consecutive 180 patients with symptomatic upper urinary tract calculi 20 mm or less were enrolled in our study underwent extracorporeal SWL were divided into two main groups, according to the stone size, Group A (92 patients with stone ≤10 mm) and Group B (88 patients with stone >10 mm). Both groups were evaluated, according to the skin to stone distance (SSD) and Hounsfield units (≤500, 500–1000 and >1000 HU). Results: Both groups were comparable in baseline data and stone characteristics. About 92.3% of Group A rendered stone-free, whereas 77.2% were stone-free in Group B (P = 0.001). Furthermore, in both group SWL success rates was a significantly higher for stones with lower attenuation 830 HU (P < 0.034). SSD were statistically differences in SWL outcome (P < 0.02). Simultaneous consideration of three parameters stone size, stone attenuation value, and SSD; we found that stone-free rate (SFR) was 100% for stone attenuation value 10 mm but total number SWL sessions and shock waves required for the larger stone group were higher than in the smaller group (P < 0.01). Furthermore, SFR was 83.3% and 37.5% for stone 830, SSD 90 mm and SSD >120 mm, respectively. On the other hand, SFR was 52.6% and 28.57% for stone >10 mm, mean HU >830, SSD 120 mm, respectively. Conclusion: Stone size, stone density (HU), and SSD is simple to calculate and can be reported by radiologists to applying combined score help to augment predictive power of SWL, reduce cost, and improving of treatment strategies.

Background: Ultrasound-guided transversus abdominis plane (TAP) block has been used for intra- and post-operative analgesia during abdominal operations and for ureteric shock wave lithotripsy (SWL) as well. Aim: This study aimed at comparing ultrasound-guided unilateral versus bilateral TAP blocks as analgesic techniques for unilateral ureteric SWL. Settings and Design: Prospective randomized comparative study. Patients and Methods: Sixty patients scheduled for unilateral ureteric SWL were randomly allocated into two groups: Group (U) received unilateral TAP block in the form of 25 ml of bupivacaine 0.25% (i.e., 62.5 mg), and Group (B) received bilateral TAP blocks in the form of 25 ml of bupivacaine 0.25% (i.e., 62.5 mg) on each side. Statistical Analysis: This was performed using SPSS program version 19 ((IBM Corp., Armonk, NY, USA) and EP 16 program. Results: The mean values of intra- and post-procedural visual analog scale at different time intervals were around (30), which was statistically insignificant between groups (P > 0.05). There were no significant differences between groups regarding cardiopulmonary stability, postanesthesia care unit time, the total amount of rescue fentanyl and patient satisfaction scores (P > 0.05). There were no significant side effects in both groups. Conclusion: Ultrasound-guided unilateral TAP block is as safe and effective analgesic technique as bilateral TAP blocks during unilateral ureteric SWL. It can be used as the sole analgesic technique during ureteric SWL.

Mycotoxins are common food contaminants which cause poisoning and severe health risks to humans and animals. The present study applied chemometric approach in liquid chromatography-tandem mass spectrometry (LC-MS/MS) optimization for simultaneous determination of mycotoxins, i.e., aflatoxins B1, B2, G1, and G2, and ochratoxin A. The validated quick, easy, cheap, effective, rugged, and safe (QuEChERS)-LC-MS/MS method was used to study the occurrence of mycotoxins in 120 food matrices. The recovery ranges from 81.94% to 101.67% with relative standard deviation (RSD) lesser than 11%. Through the developed method, aflatoxins were detected in raisin, pistachio, peanut, wheat flour, spice, and chili samples with concentration ranges from 0.45 to 16.93 µg/kg. Trace concentration of ochratoxin A was found in wheat flour and peanut samples which ranged from 1.2 to 3.53 µg/kg. Some of the tested food samples contained mycotoxins of above the European legal maximum limit.

This research investigates the association between corporate social responsibility and cash holdings, while also exploring the moderating effect of board gender diversity on this association. The study utilizes a dataset of non-financial firms listed on the Egyptian Exchange (EGX) from 2012 to 2021, comprising a final sample of 52 firms with a total of 520 firm-year observations. A statistical analysis was performed using pooled OLS, a fixed effects regression analysis, and two-step system GMM estimations to test the research hypotheses. The results show a significant positive association between CSR and cash holdings. Further, board gender diversity is found to have a negative moderating role as it weakens the association between CSR and cash holdings. These findings are relevant for regulators, investors, and stakeholders in Egypt and other emerging markets. Companies are encouraged to prioritize gender diversity in board appointments, while regulators should track and promote female representation in all listed firms. Investors are advised to focus on boards with strong female representation and high CSR disclosure. The insights offered by this research extend the literature by examining the moderating role of gender diversity in an unexplored context, namely Egypt, which fill part of the gap in early studies. [ABSTRACT FROM AUTHOR]

This study examines the impact of remote audit quality (RAQ) on the quality of audit work (QAW). Further, it explores the moderating effect of both client technological readiness (CLTR) and auditor technology readiness (ADTR) on the link between RAQ and QAW. Data were collected through a questionnaire survey distributed to all external auditors working in Egypt. The final sample consists of 280 auditors. The data were analyzed with smart partial least squares (Smart-PLS) software. The results showed that RAQ has a positive and significant impact on QAW. Moreover, the results revealed that CLTR and ADTR moderate the relationship between RAQ and QAW. CLTR was found to have a positive moderating role, as CLTR was found to strengthen the relationship between RAQ and QAW, while ADTR was found to have a negative moderating role, as ADTR was found to weaken the relationship between RAQ and QAW. The findings can provide a pivotal yardstick for guiding companies, auditing firms, auditing professional bodies, and regulators in the Egyptian context. Positioned as one of the early studies to concentrate on the moderating role of CLTR and ADTR in the relationship between RAQ and QAW, this research suggests insights within an emerging market context. [ABSTRACT FROM AUTHOR]