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Background: Cow milk protein (CMP) is the most common cause of food allergy in infants and young children. CMP allergy (CMPA) can affect more than one system, such as the skin, respiratory, or digestive systems. Gastrointestinal tract manifestations are nonspecific. One of the most important GI manifestations of CMPA is bloody stool. Purpose: This study aims to describe how many infants with GI manifestations of CMPA presented with bloody stool as it was a very annoying symptom to the family and describe how can be managed adequately. Methods: This study included 100 patients with gastrointestinal manifestations of CMPA, their ages ranged from 8 weeks to 2 years. 52 males and 48 females. All study patients were subjected to complete history, thorough clinical examination, imaging necessary, and laboratory investigations Results: bloody diarrhea was recorded in 23 patients, and 2 of them were diagnosed with food protein-induced enterocolitis syndrome (FPIES). Occult blood was detected in 11 patients in the diarrhea group (33.33%), 17 patients in the GER group (47.2%), and was detected in 5 patients (83.33%) who presented constipation associated with massive abdominal distension.

This study investigates the effect of various parameters on the fluid flow characteristic of nanosilica enhanced two phase (oil–water) flow in the pipeline using experimental and data driven approach. Levenberg-Marquardt (LM) algorithm and Scaled Conjugate gradient (SC) were used for training 20 Artificial Neural Network (ANN) model configurations. The ANN model configurations were optimized using 1 to 20 hidden neurons. Optimized ANN architecture of 3–6-3 and 3–17-3 was obtained for the LM and SC trained ANN. The performance of both the LM and SC trained ANN models were adjudged using mean square error (MSE) and the coefficient of determinant (R). Both the optimized LM and SC trained ANN architecture accurately modeled the prediction of kinematic viscosity, dynamic viscosity, and the pressure of the nanosilica enhanced crude oil. A very low MSE of 9.35x10-7 and 5.62x10-2 were obtained for the optimized LM and SC trained ANN architecture, respectively with R values of 0.999. This is an indication of the robustness of the ANN technique used in modeling the effect of the various predictors on the fluid flow characteristic of nanosilica enhanced mixture in pipelines. The sensitivity analysis revealed that the nanosilica concentration has the most significant influence on the various outputs from the ANN model.

Background and Purpose: The spectrum of brain infarction in patients with embolic stroke of undetermined source (ESUS) has not been well characterized. Our objective was to define the frequency and pattern of brain infarcts detected by magnetic resonance imaging (MRI) among patients with recent ESUS participating in a clinical trial. Methods: In the NAVIGATE ESUS trial (New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial Versus ASA to Prevent Embolism in Embolic Stroke of Undetermined Source), an MRI substudy was carried out at 87 sites in 15 countries. Participants underwent an MRI using a specified protocol near randomization. Images were interpreted centrally by those unaware of clinical characteristics. Results: Among the 918 substudy cohort participants, the mean age was 67 years and 60% were men with a median (interquartile range) of 64 (26–115) days between the qualifying ischemic stroke and MRI. On MRI, 855 (93%) had recent or chronic brain infarcts that were multiple in 646 (70%) and involved multiple arterial territories in 62% (401/646). Multiple brain infarcts were present in 68% (510/755) of those without a history of stroke or transient ischemic attack before the qualifying ESUS. Prior stroke/transient ischemic attack ( P 0 ( P P =0.01) were associated with multiple infarcts. Topographically, large and/or cortical infarcts were present in 89% (757/855) of patients with infarcts, while in 11% (98/855) infarcts were exclusively small and subcortical. Among those with multiple large and/or cortical infarcts, 57% (251/437) had one or more involving a different vascular territory from the qualifying ESUS. Conclusions: Most patients with ESUS, including those without prior clinical stroke or transient ischemic attack, had multiple large and/or cortical brain infarcts detected by MRI, reflecting a substantial burden of clinical stroke and covert brain infarction. Infarcts most frequently involved multiple vascular territories. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02313909.

Current evidence supports the use of intravenous thrombolysis with alteplase in patients with wake-up stroke selected with MRI or perfusion imaging and is recommended in clinical guidelines. However, access to advanced imaging techniques is often scarce. We aimed to determine whether thrombolytic treatment with intravenous tenecteplase given within 4·5 h of awakening improves functional outcome in patients with ischaemic wake-up stroke selected using non-contrast CT.TWIST was an investigator-initiated, multicentre, open-label, randomised controlled trial with blinded endpoint assessment, conducted at 77 hospitals in ten countries. We included patients aged 18 years or older with acute ischaemic stroke symptoms upon awakening, limb weakness, a National Institutes of Health Stroke Scale (NIHSS) score of 3 or higher or aphasia, a non-contrast CT examination of the head, and the ability to receive tenecteplase within 4·5 h of awakening. Patients were randomly assigned (1:1) to either a single intravenous bolus of tenecteplase 0·25 mg per kg of bodyweight (maximum 25 mg) or control (no thrombolysis) using a central, web-based, computer-generated randomisation schedule. Trained research personnel, who conducted telephone interviews at 90 days (follow-up), were masked to treatment allocation. Clinical assessments were performed on day 1 (at baseline) and day 7 of hospital admission (or at discharge, whichever occurred first). The primary outcome was functional outcome assessed by the modified Rankin Scale (mRS) at 90 days and analysed using ordinal logistic regression in the intention-to-treat population. This trial is registered with EudraCT (2014-000096-80), ClinicalTrials.gov (NCT03181360), and ISRCTN (10601890).From June 12, 2017, to Sept 30, 2021, 578 of the required 600 patients were enrolled (288 randomly assigned to the tenecteplase group and 290 to the control group [intention-to-treat population]). The median age of participants was 73·7 years (IQR 65·9-81·1). 332 (57%) of 578 participants were male and 246 (43%) were female. Treatment with tenecteplase was not associated with better functional outcome, according to mRS score at 90 days (adjusted OR 1·18, 95% CI 0·88-1·58; p=0·27). Mortality at 90 days did not significantly differ between treatment groups (28 [10%] patients in the tenecteplase group and 23 [8%] in the control group; adjusted HR 1·29, 95% CI 0·74-2·26; p=0·37). Symptomatic intracranial haemorrhage occurred in six (2%) patients in the tenecteplase group versus three (1%) in the control group (adjusted OR 2·17, 95% CI 0·53-8·87; p=0·28), whereas any intracranial haemorrhage occurred in 33 (11%) versus 30 (10%) patients (adjusted OR 1·14, 0·67-1·94; p=0·64).In patients with wake-up stroke selected with non-contrast CT, treatment with tenecteplase was not associated with better functional outcome at 90 days. The number of symptomatic haemorrhages and any intracranial haemorrhages in both treatment groups was similar to findings from previous trials of wake-up stroke patients selected using advanced imaging. Current evidence does not support treatment with tenecteplase in patients selected with non-contrast CT.Norwegian Clinical Research Therapy in the Specialist Health Services Programme, the Swiss Heart Foundation, the British Heart Foundation, and the Norwegian National Association for Public Health.

Herein, Keggin-type heteropolyacid (SiMo12) supported on magnetic polythiophene nanocomposite has been successfully synthesized. The obtained Fe3O4@SiO2@PT\SiMo12 magnetic nanocomposite has been characterized by XRD, FESEM and the relating XEDS energy mapping, UV–vis DRS, ICP-MS, and VSM. The catalytic and photocatalytic oxidative desulfurization (ODS) activities of the synthesized nanocatalysts were studied with T, BT, and DBT as the model sulfur compounds. Results showed that the Fe3O4@SiO2@PT\SiMo12 nanocatalyst exhibited significantly higher catalytic and photocatalytic ODS activities than pure SiMo12, PT, and Fe3O4@SiO2@PT at the same experimental conditions. In general, Fe3O4@SiO2@PT\SiMo12 showed higher photocatalytic ODS (under visible light) activity (97.2%, 99% and 99.7%) than catalytic ODS (87%, 89.6% and 96.2%) for T, BT, and DBT respectively after 45 min. Also, the Fe3O4@SiO2@PT\SiMo12 nanocatalyst possessed excellent stability after five reaction cycles.

Rotating disks are applied in many industrial heat and mass transfer systems because of their high mixing performance. The presence of non-Newtonian viscous liquids in these systems limits the mixing performance, thereby affecting the required heat and mass transfer. In this study, passive, active, and interactive drag-reduction techniques are proposed to enhance the mixing and drag-reduction performance of rotating disks and are experimentally tested. An SV-grooved surface (triangular shaped) is engraved on a disk attached to a rotating disk apparatus to test the liquid resistance based on torque readings and the velocity profile using a miniature laser Doppler velocimeter (Mini-LDV, MicroPro). The polymer polyisobutylene and the surfactant sodium lauryl ether sulfate are chosen as the passive–active integrated drag-reduction components in an experiment using different additive concentrations and polymer–surfactant complexes in the same tests. The experimental results show that the selected passive design of the riblets can enhance flow by 8% and that this percentage increases when polymeric additives and polymer-surfactant complexes are introduced. The velocity profile results show that high-velocity zones are created above the rotating surface and that these zones contribute significantly to enhancing the mixing intensity in the drag-reduction system.

Quality improvement is one of the most important requirements to strengthen a competitive position in our markets today. So improving the quality, will lead to decrease variations, shrinkages and so production costs hence the customers acquire the appropriate products and services to use. Control charts have an effective usage field to keep the process under control. Control charts are illustrated as graphical analysis method which defines the products whether to stay in the acceptable limits or not and as a graphical analysis technique that specifies a signal in the state of product to be out of that limits. In this paper by detecting basic concept and essentials beyond the control charts usage and the improvement; so it combined with fuzzy approach to detect the optimal limits. Hence the application of the proposed fuzzy control chart is in Al–Dura Refinery to monitor variable quality characteristics. The proposed fuzzy control chart is under vague, imprecise, uncertain, and incomplete data and based on α-level fuzzy midrange for α – cut approach. As a result of the application, it’s rational to say that constructing fuzzy control charts have a more flexible, a more convenient mathematical characterization concept and have more reasonable results than the traditional quality control chart techniques.

Background: High blood pressure is common in acute stroke and is a predictor of poor outcome; however, large trials of lowering blood pressure have given variable results, and the management of high blood pressure in ultra-acute stroke remains unclear. We investigated whether transdermal glyceryl trinitrate (GTN; also known as nitroglycerin), a nitric oxide donor, might improve outcome when administered very early after stroke onset.Methods: We did a multicentre, paramedic-delivered, ambulance-based, prospective, randomised, sham-controlled, blinded-endpoint, phase 3 trial in adults with presumed stroke within 4 h of onset, face-arm-speech-time score of 2 or 3, and systolic blood pressure 120 mm Hg or higher. Participants were randomly assigned (1:1) to receive transdermal GTN (5 mg once daily for 4 days; the GTN group) or a similar sham dressing (the sham group) in UK-based ambulances by paramedics, with treatment continued in hospital. Paramedics were unmasked to treatment, whereas participants were masked. The primary outcome was the 7-level modified Rankin Scale (mRS; a measure of functional outcome) at 90 days, assessed by central telephone follow-up with masking to treatment. Analysis was hierarchical, first in participants with a confirmed stroke or transient ischaemic attack (cohort 1), and then in all participants who were randomly assigned (intention to treat, cohort 2) according to the statistical analysis plan. This trial is registered with ISRCTN, number ISRCTN26986053.Findings: Between Oct 22, 2015, and May 23, 2018, 516 paramedics from eight UK ambulance services recruited 1149 participants (n=568 in the GTN group, n=581 in the sham group). The median time to randomisation was 71 min (IQR 45–116). 597 (52%) patients had ischaemic stroke, 145 (13%) had intracerebral haemorrhage, 109 (9%) had transient ischaemic attack, and 297 (26%) had a non-stroke mimic at the final diagnosis of the index event. In the GTN group, participants' systolic blood pressure was lowered by 5·8 mm Hg compared with the sham group (pvs 3 [2–5]; n=558, in the sham group; 1·04 [0·84–1·29]; p=0·69). We found no difference in secondary outcomes, death (treatment-related deaths: 36 in the GTN group vs 23 in the sham group [p=0·091]), or serious adverse events (188 in the GTN group vs 170 in the sham group [p=0·16]) between treatment groups.Interpretation: Prehospital treatment with transdermal GTN does not seem to improve functional outcome in patients with presumed stroke. It is feasible for UK paramedics to obtain consent and treat patients with stroke in the ultra-acute prehospital setting.Funding: British Heart Foundation.

In this paper, the ability of three types of drag reduction agents (DRAs) has been investigated to assess the impact of adding a small amount part per million (ppm) of polymer and surfactant, as well as nanoparticle substances, as drag improvers of internal flow via a pipeline network. The selected DRAs have been tested in the rotating disk apparatus (RDA) at various concentrations in the range of (50-1200) ppm and various rotating disk velocities in the range of (50-3000) rpm. Multiple trials have been done to figure out the best substance for enhancing drag force reduction. Impacts of the shear rate on viscosity (μ) at various concentrations of polymer and surfactant solutions have been analyzed with rheologic tests. The results detect that all selected substances have proved to be effective drag improvers in internal flow. Torque values were decreased with increased DRA concentrations, which caused a significant increase in drag reduction percentage (%DR). The drag reduction percentage of complex solutions at the highest concentration of 1200 ppm, results in around (44-47) % DR. In contrast, the results of the individual solutions at the same concentration results in around (32-38) % DR.

Research was undertaking to evaluate the ability of pomegranate peel in removing heavy metal cations Cu+2, Cd+2 & Zn+2 from wastewater. Simulated artificial water via batch adsorption approach was used in this study. Pomegranate peel was cleaned thoroughly to remove dust and dirt before drying them. Next, the peels were grinded (approximately less than 1mm in size) and directly used in different adsorbent/metal ion ratios. The metal ion concentration begins from 1000 ppm. The effect of contact duration, initial concentration of metal ion and loading weight of adsorbent on the percentage of heavy metal removal were investigated. The experiment was conducted at room temperature of 25 °C and pH value was maintained at the range of 5 to 6. From the observation and analysis, it was found that pomegranate peel successfully removed the heavy metals. The removal percentage observed was 80% for Cu+2 ions, 50.5% for Cd+2 ions and 32.5% for Zn+2 ions. The removal percentage was achieved within an hour of contact with an adsorbent loading ratio of 30 g/l. However, the removal percentage of mixed ions was relatively low, resulting from competition and interaction between the ions. The Pomegranate peel is available in huge quantities, low cost and can be used as an efficient metal ion adsorbent.

One of the economical important challenges in pipeline transportation is reducing the drag; e.g reducing the pressure drop along the pipe as much as possible. Although many efforts have been made, a universal mechanism and environmentally friendly approach to reduce the drag is still setbacks. The present work introduces an environmentally friendly method to reduce drag using microbubble, polyethylene oxide (PEO) with concentrations (100, 400,1100,1900 and 2500 ppm) and nanopaticles (carbon nano tube CNT) with concentrations (100, 400,1100,1900 and 2500 ppm). The pipeline loop was used to individually study the materials, their complexes as well as the combination of either of these with micro bubbles. The experiments were conducted in a pipeline loop to mimic the practice in the petroleum industries. The result showed that the drag reduction increases as flow and additive concentraons increases and the maximum reduction was 40% for PEO and 58% for CNT. The results also show that the use of blend additives has greater effect than the individual materials and combining the polymer, CNT suspended, and the microbubbles gave 80% drag reduction.

Background: \ud Patent foramen ovale (PFO) is a contributor to embolic stroke of undetermined source (ESUS). Subgroup analyses from previous studies suggest that anticoagulation could reduce recurrent stroke compared with antiplatelet therapy. We hypothesised that anticoagulant treatment with rivaroxaban, an oral factor Xa inhibitor, would reduce the risk of recurrent ischaemic stroke compared with aspirin among patients with PFO enrolled in the NAVIGATE ESUS trial.\ud \ud Methods: \ud NAVIGATE ESUS was a double-blinded, randomised, phase 3 trial done at 459 centres in 31 countries that assessed the efficacy and safety of rivaroxaban versus aspirin for secondary stroke prevention in patients with ESUS. For this prespecified subgroup analysis, cohorts with and without PFO were defined on the basis of transthoracic echocardiography (TTE) and transoesophageal echocardiography (TOE). The primary efficacy outcome was time to recurrent ischaemic stroke between treatment groups. The primary safety outcome was major bleeding, according to the criteria of the International Society of Thrombosis and Haemostasis. The primary analyses were based on the intention-to-treat population. Additionally, we did a systematic review and random-effects meta-analysis of studies in which patients with cryptogenic stroke and PFO were randomly assigned to receive anticoagulant or antiplatelet therapy.\ud \ud Findings: \ud Between Dec 23, 2014, and Sept 20, 2017, 7213 participants were enrolled and assigned to receive rivaroxaban (n=3609) or aspirin (n=3604). Patients were followed up for a mean of 11 months because of early trial termination. PFO was reported as present in 534 (7·4%) patients on the basis of either TTE or TOE. Patients with PFO assigned to receive aspirin had a recurrent ischaemic stroke rate of 4·8 events per 100 person-years compared with 2·6 events per 100 person-years in those treated with rivaroxaban. Among patients with known PFO, there was insufficient evidence to support a difference in risk of recurrent ischaemic stroke between rivaroxaban and aspirin (hazard ratio [HR] 0·54; 95% CI 0·22–1·36), and the risk was similar for those without known PFO (1·06; 0·84–1·33; pinteraction=0·18). The risks of major bleeding with rivaroxaban versus aspirin were similar in patients with PFO detected (HR 2·05; 95% CI 0·51–8·18) and in those without PFO detected (HR 2·82; 95% CI 1·69–4·70; pinteraction=0·68). The random-effects meta-analysis combined data from NAVIGATE ESUS with data from two previous trials (PICSS and CLOSE) and yielded a summary odds ratio of 0·48 (95% CI 0·24–0·96; p=0·04) for ischaemic stroke in favour of anticoagulation, without evidence of heterogeneity.\ud \ud Interpretation: \ud Among patients with ESUS who have PFO, anticoagulation might reduce the risk of recurrent stroke by about half, although substantial imprecision remains. Dedicated trials of anticoagulation versus antiplatelet therapy or PFO closure, or both, are warranted.\ud \ud Funding: \ud Bayer and Janssen.

The fecal bacteria have been taken as the gold standard for water industry. However, the spread of viral gastroenteritis due to drinking water have given a momentum to a recent push by microbiologists to consider viruses as important pollution indicator as fecal bacteria. Therefore, we designed a study to evaluate the efficiency of two types of water purification systems: the traditional water treatment plant and two types compact units. Both systems produced drinking waters free of bacteria, chemical contaminants and mostly viruses free. However, recent advances in molecular biology techniques, such as RT-PCR have detected Rotaviruses in chlorinated drinking waters resulted from all systems. The frequency of Rotaviruses since October 2010 till September 2012 in Shark El-Mansoura WTP in drinking water samples was 12.5% similar to raw water. While the compact unit at Depo Awam (American design) the frequency of Rotavirus was 16.6% in both raw and drinking water samples. On the other hand the virus frequency in the raw and drinking water sample in El-Danabik unit (Egyptian design) were 12.5% and 4.16% respectively. Signifying failure of the chlorination process in removing viruses completely. However, detection of Rotavirus genome in the drinking water samples does not means the presence of its infectivity. The infectious ability of the rotaviruses was confirmed by CC-RT-PCR in all positive samples, where viral RNA was not detected in the collected drinking water samples. In conclusion RT-PCR and CC-RT-PCR techniques high lightened the need to include viruses as mandatory pollution indicator in water treatment plants. Int J Appl Sci Biotechnol, Vol 3(3): 528-536

A fuel cell can be best defined as an electrochemical converter of fuel and oxidant of chemical energy to electrical energy. The important components of micro fuel cells are the electrodes and catalysts because the kinetics and rates of the electrochemical reactions depend on their materials. All fuel cells consist of two electrodes: the anode, where fuel oxidation takes place, and the cathode, which is used to reduce the oxidants. The present review article highlights the use of a range of electrodes made up of different materials, a variety of catalysts that have been used in previous studies, and their fabrication materials and approaches. In this article, electrodes and catalysts are classified into two types based on the design approach applied to produce the micro fuel cell: micro fuel cell design and conventional assembly design. Most previous studies on fuel cells have demonstrated that the construction and position of the electrodes play crucial roles in improving the performance of micro fuel cells.

Background : Foreign body (FB) ingestion is a worldwide problem, commonly occurs in children younger than 6 years, and the incidence of FBI has increased in recent years. Aim : To review our experience of FB ingestions management in children over a 7 year period and compared our findings with previous reports. Patients and Methods : The medical records of 250 patients who were hospitalized for FB ingestion between 2007 and May 2014 were evaluated retrospectively. The age and sex, clinical findings, diagnostic methods, modalities of treatment as well as outcome of all patients were noted. Statistical Analysis : Descriptive. Results : There were 250 patients enrolled into the study. The main presenting symptoms were abdominal pain (38%), vomiting (6.4%), dysphagia (3.2%), chest pain (3.2%), cough (2.4%), and melena (1.2%). No symptom was encountered in the remaining (45.6%) patients. Radiological examinations showed that FB was located in the esophagus in 44.8%, in the stomach of 35.2%, in the duodenum of 1.2%, and in the intestine or colon segments in 18.8% (n = 47) patients. Conclusions : We concluded that the public health education could reduce exposure to injuries from FB ingestion and we found the endoscopic extraction of FB is safe and effective.

Objectives:Turbulent Drag Reduction (DR) efficacy of diesel fuelin a Rotating Disk Apparatus (RDA) using anionic surfactant of Sodium Lauryl Ether Sulfate (SLES) was investigated with smooth andSV-groove disks(riblets height of 900 and 3100 μm). Methods: The DR efficacy indicates how the torque is being reduced with a tiny amount of additives under a turbulent flow at a Reynolds number (Re) range of 302227 to 453341. The effects of different variables such as rotary disk type (smooth or structured), surfactant concentration, and Reynolds number were also studied. Findings: SLES shows a good ability to reduce the frictional drag forces with smooth and SV-groove of height 3100μm. In contract, there is no drag reduction can be observed by using this surfactant with SV-groove of height 900 μm. Application/Improvements: The passive-active interaction method can be used to improve petroleum liquid flow in pipelines.

Background/Aims : Biliary atresia (BA) has become the most common indication for liver transplantation among pediatric recipients. The aim is to characterize the outcome and feasibility of living related liver transplantation for children with biliary atresia in Egypt; a single institutional study. Patients and Methods : We retrospectively reviewed our records in the National Liver Institute (NLI) – Hospital, Menofiya University, starting from April 2003 to the end of August 2011. There were an 11 cases were transplanted for biliary atresia. All the patients received Lt. Lateral grafts. The mean graft volume was 248±88 gm and Graft Recipient Weight Ratio (GRWR) was 2.56±0.82. Results : At the end of this study 5 patients are alive. The mean Survival Duration was 31.04±28.1 months, early mortality was reported in 3 patients. Conclusion : Our results confirmed the effectiveness of LDLT for the treatment of children with biliary atresia with failed Kasai procedures. Living related liver grafts represented an excellent organ supply for these patients.

Background and study aims Biliary atresia (BA) is the most common cause of chronic cholestasis in infants. The most important objective in such cases is to distinguish obstructive cholestasis from non-obstructive causes. Aim of the study To evaluate the hepatic histopathology for the presence of features that correlate best with the diagnosis of BA. Patients and methods We retrospectively study the data of 81 infants who presented with neonatal cholestatic syndrome (NCS) (58 diagnosed as BA and 23 as not BA). We evaluated 6 histopathological parameters including ductular proliferation, bile plugs, intracellular bile pigments, giant cells transformation, Portal cellular infiltration and fibrosis. Results The study showed that ductular proliferation, bile plugs and intracellular bile pigments emerged as the best indicators of BA while multinucleate giant cells transformation and portal cellular infiltration were seen in NH. Conclusion In developing countries, we therefore recommend doing prelaparotomy liver biopsy for all suspected cases of BA to decrease the frequency of negative laparotomy to achieve cost benefit with reduced morbidity.

Objective Diagnosing stroke-associated pneumonia (SAP) is challenging and may result in inappropriate antibiotic use or confound research outcomes. This study evaluates the diagnostic accuracy of algorithm-defined versus physician-diagnosed SAP in 1088 patients who had dysphagic acute stroke from 37 UK stroke units between 21 April 2008 and 17 May 2014. Methods SAP in the first 14 days was diagnosed by a criteria-based algorithm applied to blinded patient data and independently by treating physicians. Patients in whom diagnoses differed were reassigned following blinded adjudication of individual patient records. The sensitivity, specificity, positive predictive value (PPV) and diagnostic OR of algorithmic and physician diagnosis of SAP were assessed using adjudicated SAP as the reference standard. Agreement was assessed using the κ statistic. Results Physicians diagnosed SAP in 176/1088 (16%) and the algorithm in 123/1088 (11.3%) patients. Diagnosis agreed in 885/1088 (81.3%) patients (κ 0.22 (95% CI 0.14 to 0.29)). On a blinded review, 129/1088 (11.8%) patients were adjudicated as patients with SAP. The algorithm and the physicians had high specificity (97% (95% CI 96% to 98%) and 90% (95% CI 88% to 92%), respectively) but only moderate sensitivity (72% (95% CI 64% to 80%) and 65% (95% CI 56% to 73%), respectively) in diagnosing SAP. The algorithm showed better PPV (76% (95% CI 67% to 83%) vs 48% (95% CI 40% to 55%)), diagnostic OR (80 (95% CI 42 to 136) vs 18 (95% CI 12 to 27)) and agreement (κ 0.70 (95% CI 0.63 to 0.78) vs 0.48 (95% CI 0.41 to 0.54)) than physician diagnosis with adjudicated SAP. Conclusions Algorithm-based approaches can standardise SAP diagnosis for clinical practice and research. Trial registration number ISRCTN37118456; Post-results.

Unidirectional (UD) woven laminates have complex tow geometry due to unbalanced weave architecture. Warp tows are held together by fine weft. Unit cell models for textile composites found in the literature are based on balanced weaves with identical warp and weft specifications. In this paper, unit cell geometry of unbalanced UD weaves has been considered. Unbalanced laminates have complex tow geometry with in-plane tow waviness and a significant overlap between adjacent tows. Main objective of this work is to measure full-field strain distribution at meso-scale or unit cell level and compare the results with FE analysis. Raman spectroscopy is a powerful technique for in situ strain measurement. A UD woven composite laminate with Kevlar fibres is used in this study, as Kevlar fibres exhibit clear Raman band shifts under strain. Influence of in-plane tow waviness on local strain gradients has been demonstrated.

Background : Urinary tract infection (UTI) is a common clinical problem in febrile infants younger than 8 weeks old, with a prevalence between 5% and 11%. Previous studies have noted that jaundice may be one of the first signs of a bacterial infection in infants. Aim : is to assess the presence of urinary tract infection in newborns with unexplained, indirect hyperbilirubinemia in the first eight weeks of life. Patients and Method : This study was conducted on 100 full term and preterm neonates with neonatal jaundice, 64 males and 36 females, and 20 neonates as control group, 10 males and 10 females. Results : shows that > 90% of cases with positive urinary culture had prolonged duration of jaundice > 14 days and the maternal infection was the leading cause of UTI. Conclusion : Testing for UTI should be a part of the diagnostic evaluation of neonates with prolonged unexplained jaundice. Maternal (obstetric) infections should be properly investigated and treated to prevent UTI in newborns as it was the leading cause of UTI in neonates. Further studies are needed to clarify the effect of hyperbilirubinemia on the bactericidal activity in the sera of jaundiced infants.

The hypoglycemic activity of a 70% methanol extract from the leaves of Ailanthus excelsa Roxb. (Simaroubaceae) was studied in normal, transiently hyperglycemic and streptozotocin (STZ)-induced diabetic rats. Oral administration of the extract at doses of 14, 70 and 350 mg/kg body weight caused no significant changes in fasting blood glucose levels of normal rats. In an oral glucose tolerance test, the extract produced a significant decrease in glycemia 90 min after the glucose pulse. Daily administration of A. excelsa extract for 60 days produced a significant hypoglycemic effect in diabetic animals. In addition, this treatment improved the altered renal function observed in diabetic control rats. This study suggests that Ailanthus leaf extract could be potentially useful for post-prandial hyperglycemia treatment.

The modulation of cardiovascular responses to the cold pressor test (CPT) as produced by exercise was studied in 13 volunteers. The reproducibility of the measurements selected for the study, i.e. heart rate (HR), blood pressure (BP), blood flow (BF) and skin temperature (ST), was investigated through repeat experiments in the fall of 1994 and the winter of 1995. HR was monitored before, during and after a 10-min period of bicycling at 70% of reserve HR. BP, cutaneous BF and ST were measured before and after exercise. Two CPTs (hand into ice-cold water for 1 min) were performed: one preceding exercise and another at 3 min after exercise. The results obtained allow us to conclude that in non-hypertensive volunteers (1) the pronounced cardiovascular responses (ST, BF and BP) induced by CPT are reproducible (p > 0.2) when compared to basal level values and (2) cardiovascular responses to cold stress are significantly attenuated by exercise (p < 0.03). Our study, therefore, supports and validates the use of our coupled exercise-CPT method in ongoing epidemiological studies attempting to identify individuals at risk for the development of hypertension as well as those most likely to benefit from preventative exercise programs.

The effect of long-term use of oral contraceptive pills on lipid metabolism was the aim of this study. 200 healthy, multiparous women attending the family planning clinic in Ain Shams University Hospital, Cairo, were divided into two groups. The study group included 100 women using monophasic combined oral contraceptive pills, while the control group included 100 women using only IUDs for at least 5 uninterrupted years. Serum total lipids, cholesterol, triglycerides, and lipoproteins were estimated in both groups. It was found that serum cholesterol, triglycerides, and beta-lipoproteins were higher in pill users than in the IUD group. The level of alpha-lipoproteins showed a more significant drop in the serum of pill users than in the serum of the control group. None of these changes were correlated with body weight or duration of pill usage. The estimated serum level of total lipids was found to be high among pill users and not correlated with the duration of pill usage. This rise was insignificant in pill users having body weight less than 70 kg, but was significant in all other body weight groups.