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Abstract The reproductive technology has a significant impact on the development of livestock production. The thyme oil, rich in phytoestrogen chemicals like apigenin, has been found to enhance reproductive performance by mimicking estrogen’s action. This study aimed to investigate the effects of oral supplementation with thyme essential oil on the reproductive organ biometry, and reproductive performance in adult and prepubertal Barki ewes. Seventy ewes were treated with intravaginal sponges impregnated with 40 mg. medroxyprogesterone acetate for 14 days and simultaneously assigned randomly to two groups (20 adult and 15 prepubertal ewes per group), i.e., a control and a thyme oil treated (2.25 mg/kg body weight) group. The number of follicles, follicle diameter, corpora lutea diameter, and estrogen concentration were higher in the thyme oil-treated group than in the control group without comparing between adult ewes and prepubertal ewes. Additionally, the number and diameter of the large follicles were higher (P

Abstract Background Oral diseases remain a significant public health problem worldwide despite being largely preventable. Oral disorders such as dental caries, periodontal diseases, and oral cancers are highly prevalent chronic conditions that negatively impact quality of life. The oral health practice in Somalia has been evolving over the years, we therefore explored the challenges of oral health practice in a security-constrained poorly regulated environment to guide policy development. Methods We conducted a descriptive cross-sectional study among 15 oral health practitioners in Somalia. Using in-depth interviews, we gathered data on challenges working in private dental clinics and governmental institutions. Additionally, we gathered data on gender, age, marital status, profession, country of graduation, current location of practice, and years of clinical experience. Because the participants worked in different cities, we conducted interviews over the phone and recorded them. The data were analyzed via thematic analysis. Results In this study, 9 of the participants were men and the median age was 29 years. Most of the participants (10) were dentists and remaining were dental specialists. The findings on challenges fall under four broad thematic areas: (1) Patient-related challenges; low patient literacy, preference for dental quacks, delay in seeking oral care, and dental phobia. (2) Institutional-related challenges: limited access to basic oral health services, oral health not an integral part of primary health care, and unregulated private dental clinics resulting in unqualified quacks practising as private caregivers. (3) Societal-related challenges, the absence of community-oriented preventive oral health services and low prioritization of oral health. (4) Personal-related challenges: female dentists in this study faced challenges related to the preference of male dentists and the shortage of oral health specialists in the country. Conclusion This study reveals the need for the establishment and strengthening of regulation of oral services and its inclusion into the basic primary service package provided to the populace. It also calls for community enlightenment and more investment in dental health care in Somalia. Clinical trial number Not applicable.

Abstract Introduction Inadequate care for asthma has been linked to higher hospital admissions and morbidity. Researchers have developed several strategies to improve treatment adherence in this specific group. We aimed to investigate the impact of several interventions on the adherence of asthmatic patients to controller inhalers. Data sources We searched four databases (the Cochrane Library, PubMed, Embase, and Web of Science) for studies published between 1998 and 2022. Study selections We considered studies that assessed adherence as the main finding of an intervention for asthma patients. Data were extracted and analyzed. Results The analysis included a total of 40 studies. A diverse range of interventions was identified, including educational sessions on asthma, reminders via text messages, and technology-based feedback systems. The overall efficacy of interventions compared to the control group resulted in a small effect size, but it was statistically significant, with an estimated SMD of 0.44 (95% CI 0.24 to 0.63, P

Abstract Breeding high yielding water-deficit tolerant rice is considered a primary goal for achieving the objectives of the sustainable development goals, 2030. However, evaluating the performance of the pre-breeding-promising parental-lines for water deficit tolerance prior to their incorporation in the breeding program is crucial for the success of the breeding programs. The aim of the current investigation is to assess the performance of a set of pre-breeding lines compared with their parents. To achieve this goal a set of 7 pre-breeding rice lines along with their parents (5 genotypes) were field evaluated under well-irrigated and water-stress conditions. Water stress was applied by flush irrigation every 12 days without keeping standing water after irrigation. Based on the field evaluation results, a pre-breeding line was selected to conduct physiological and expression analysis of drought related genes at the green house. Furthermore, a greenhouse trial was conducted in pots, where the genotypes were grown under well and stress irrigation conditions at seedling stage for physiological analysis and expression profiling of the genotypes. Results indicated that the pre-breeding lines which were high yielding under water shortage stress showed low drought susceptibility index. Those lines exhibited high proline, SOD, TSS content along with low levels of MDA content in their leaves. Moreover, the genotypes grain yield positively correlated with proline, SOD, TSS content in their leaves. The SSR markers RM22, RM525, RM324 and RM3805 were able to discriminate the tolerant parents from the sensitive one. Expression levels of the tested drought responsive genes revealed the upregulation of OsLEA3, OsAPX2, OsNAC1, OSDREB2A, OsDREB1C, OsZIP23, OsP5CS, OsAHL1 and OsCATA genes in response to water deficit stress as compared to their expression under normal irrigated condition. Taken together among the tested pre-breeding lines the RBL112 pre-breeding line is high yielding under water-deficit and could be used as donor for high yielding genes in the breeding for water deficit resistance. This investigation withdraws attention to evaluate the promising pre-breeding lines before their incorporation in the water deficit stress breeding program.

Introduction Healthcare systems in developing countries faced significant challenges during COVID-19, grappling with limited resources and staffing shortages. Assessment of the impact of pharmaceutical care expertise, particularly in critical care units during the pandemics, in developing countries remains poorly explored. The principal aim of our study was to assess the impact of the Drug and Therapeutics Committee (DTC), comprising clinical pharmacists, on the incidence, types, and severity of medication errors and associated costs in using COVID-19 medications, especially antibiotics.Methods An interventional pre–post study was carried out at a public isolation hospital in Egypt over 6 months.Results Out of 499 medication orders, 238 (47.7%) had medication errors, averaging 2.38 errors per patient. The most frequent were prescribing errors (44.9%), specifically incorrect drug choice (57.9%), excessive dosage (29.9%), treatment duplication (4.5%), inadequate dosage (4.5%), and overlooked indications (3.6%). Linezolid and Remdesivir were the most common medications associated with prescribing errors. Pharmacists intervened 315 times, primarily discontinuing medications, reducing doses, introducing new medications, and increasing doses. These actions led to statistically significant cost reductions (p

Abstract Background The nutritional status and growth of children with Autism spectrum disorders (ASD) is influenced significantly by two factors; food selectivity behaviors due to their consumption of a limited variety of food and the high incidence of gastrointestinal (GIT) disorders. Aim This study aimed to assess the nutritional adequacy and growth pattern of ASD children aged three to twelve years compared to their healthy developing peers. Methods A national comparative, facility-based cross-sectional study was conducted in eight Egyptian governorates on 285 Egyptian children diagnosed with ASD and 224 children who are their relatives as healthy developing peers. Anthropometric measurements were obtained, including weight, height, head circumference, and mid-upper arm circumference. Body Mass Index (BMI) was calculated and all numbers were plotted on WHO growth charts. Assessment of food preferences, and nutrient intake adequacy of children was done using the Food preference questionnaire, and the Dietary Reference Intakes (DRIs) of Egyptian children. Results Calorie-dense food and sugar intake were higher among ASD children than their healthy developing peers. ASD children omit some important protein sources such as dairy (COR = 5.2, 95% CI:2.7–9.9), meat, and poultry (COR = 2.7, 95% CI: 1.6–4.7), and a lower intake of fruits and vegetables than their healthy developing peers. For children with ASD in all age groups, a deficiency in the range of 50–60% was detected for vitamins (C, D, B6, thiamine, riboflavin, niacin) and minerals (iron). A deficiency in the range of 60–70% was detected for folate and calcium. A deficiency of vitamin C calcium and iron was also detected for both children with ASD and their healthy developing relatives aged 6 to 12 years. GIT disorders were common among ASD children compared to healthy developing peers (COR = 2.8 to 10.3). Children with ASD had four-fold higher odds of stunting (COR = 4.1, CI: 1.7–10.1), threefold higher odds of being overweight (COR = 3.3, CI: 1.48–7.32), and nearly eleven-fold higher odds of obesity (COR = 11.4, CI: 4.05–32.17) compared to their healthy developing peers. Conclusion ASD children are prone to overweight and protein malnutrition. Their intake of fruits and vegetables is inadequate and hence their intake of vitamins and minerals is insufficient, contributing to stunting.

Abstract Climate change, driven by human activities and natural processes, has led to critical alterations in varying patterns during cropping seasons and is a vital threat to global food security. The climate change impose several abiotic stresses on crop production systems. These abiotic stresses include extreme temperatures, drought, and salinity, which expose agricultural fields to more vulnerable conditions and lead to substantial crop yield and quality losses. Plant hormones, especially salicylic acid (SA), has crucial roles for plant resiliency under unfavorable environments. This review explores the genetics and molecular mechanisms underlying SA's role in mitigating abiotic stress-induced damage in plants. It also explores the SA biosynthesis pathways, and highlights the regulation of their products under several abiotic stresses. Various roles and possible modes of action of SA in mitigating abiotic stresses are discussed, along with unraveling the genetic mechanisms and genes involved in responses under stress conditions. Additionally, this review investigates molecular pathways and mechanisms through which SA exerts its protective effects, such as redox signaling, cross-talks with other plant hormones, and mitogen-activated protein kinase pathways. Moreover, the review discusses potentials of using genetic engineering approaches, such as CRISPR technology, for deciphering the roles of SA in enhancing plant resilience to climate change related abiotic stresses. This comprehensive analysis bridges the gap between genetics of SA role in response to climate change related stressors. Overall goal is to highlight SA's significance in safeguarding plants and by offering insights of SA hormone for sustainable agriculture under challenging environmental conditions.

Abstract Introduction Improving breastfeeding practices does not always link to interventions relying only on improving nutrition awareness and education but needs cultural and behavioral insights . Aim This study aimed to evaluate the changes in core breastfeeding indicators as a result of the use of social marketing (SM) approach for improving breastfeeding practices of Egyptian women and the physical growth of infants aged 6 to 12 months. The core breastfeeding indicators were: Early initiation of breastfeeding within one hour of birth, Predominant and exclusive breastfeeding to 6 months (EBF), Bottle feeding with formula, continued breastfeeding to 1 and 2 years, and responsiveness to cues of hunger and satiety. Methods A quasi-experimental longitudinal study with a posttest-only control design was done over 3 years in three phases; the first was in-depth interviews and formative research followed by health education and counseling interventions and ended by measuring the outcome. Motivating mothers’ voluntary behaviors toward breastfeeding promotion “feeding your baby like a baby” was done using SM principles: product, price, place, and promotion. The interventions targeted 646 pregnant women in their last trimester and delivered mothers and 1454 women in their childbearing period. The statistical analysis was done by using SPSS program, version 26. Results Most mothers showed significantly increased awareness about the benefits of breastfeeding and became interested in breastfeeding their children outside the house using the breastfeeding cover (Gawn) (p

Purpose: To determine the effect of electromagnetic waves of mobile phone stations on several sperm parameters and the male reproductive system. Methods: This observational study was performed on 216 subjects, aged 18-60 years. Two equal groups of subjects were assigned to group A (study group) if they were living close to cell phone tower stations for at least 6 months and group B (control group) formed from individuals living 100 meters away from cell phone tower stations. Every subject underwent a comprehensive history taking, a clinical assessment, and laboratory testing. Results: Regarding morphology index in the studied groups, the exposed group exhibited a trend of reduced percentage of normal morphology compared to the non-exposed group, with no statistical difference between the two groups. Regarding the total sperm motility (A+B+C) and progressive sperm motility (A+B) in the studied groups, the exposed group showed a trend of decreased total sperm motility and of progressive sperm motility in contrast to the non-exposed group, with no statistical difference between the two groups. Conclusions: Personal wrong lifestyles with exposure to electromagnetic waves have shown a trend towards a reduced percentage of normal morphology and reduced motility although nonstatistically significant compared with non-exposed populations.

Prostate cancer (PCa) is a prevalent form of malignancy in males and is a significant contributor to cancer-related mortality worldwide. Because of this, studying the molecular processes of PCa cell growth and death is crucial. Hence, it is imperative to conduct further research on the regulatory mechanism underlying the progression of PCa to enhance our comprehension and identify innovative therapeutic targets. The present study investigates an experimental approach that utilizes cost-effective and environmentally sustainable plant extracts sourced from Egypt, namely ginger, chamomile, and green tea, which have been solubilized in dimethyl sulfoxide (DMSO), then characterized by using different analytical means and techniques, such as HPLC and GC–MS. The present study employed MTT assay, ELISA, and qRT-PCR techniques to assess the possible impact of the investigated extracts on PCa in PC-3 cells. The findings indicate that ginger exhibited a noteworthy cytotoxic impact on PC-3. Remarkably, the treatment of PCa cells with ginger significantly increased relative lactate dehydrogenase (LDH) production compared to those treated with chamomile and green tea extracts. Autophagy may play a crucial role in the context of chemotherapy. Modifying autophagy through its induction or inhibition is a promising and innovative approach to control cancer progression. Accordingly, it was found that ginger extract affects protein expression levels of autophagy markers LC3B, ATg12, and pro‐apoptotic signaling, including the Caspase-3 signaling pathway. The ELISA findings revealed a significant rise in the average levels of IL-1β and IL-8 after a 12-hour interval. To conclude, it can be inferred that ginger extract possesses the capability to control the production of inflammatory cytokines. Alternatively, utilizing herbal remedies containing ginger as a viable and secure means of treating PCa as an anticancer agent is possible.

Abstract Background Dengue has become an alarming global problem and is endemic in many countries, particularly in tropical and subtropical countries. The aim of this study was to investigate dengue fever outbreak in Banadir Region, Somalia, to understand the risk factors (time, place, personal characteristics). Methods A descriptive cross-sectional study was undertaken to determine the levels of circulating anti-dengue virus antibodies and DENV NS1 antigen among Banadir Region residents, while a questionnaire survey was conducted to understand the clinical and demographic characteristics of the patients. Results A total of 735 febrile patients were studied, with 55.6% men and 44.3% women. The majority of the participants were children aged 14 years and younger. Among them, 10.8% tested positive for IgM antibodies against dengue virus (DENV), while the prevalence of DENV NS1 antigen was 11.8%. Fever and myalgia were the most common symptoms observed in the DENV-positive patients. Conclusions A dengue fever outbreak has been confirmed in Banadir region, Somalia. This study provides information on the most affected districts and identifies risk factors contributing to DF outbreaks. The study recommends improving outbreak readiness and response, particularly in surveillance and laboratory diagnostics, by fostering intersectoral collaboration and establishing regulatory frameworks for financial and operational participation.

Abstract Background Metastatic tumors account for 80% of all lung tumors in children. Wilms tumour and osteosarcoma are the most tumors of childhood that produce lung metastases. The aim of the current study is to assess the prognostic factors of pulmonary metastatectomy in pediatric solid tumours as age, number, size, site,laterality, resectability of pulmonary nodules, and number of Thoracotomies. Calculate overall survival among patients who underwent pulmonary metastatectomy. Methods It is a retrospective study including all pediatric patients with metastatic solid tumors to lungs treated at pediatric oncology department, National Cancer Institute, Cairo University from 2008 to 2014. Fifty-five patients were included, 43 (78.2℅) patients of them had Osteosarcoma. Results Thirty (54.5℅)patients were male. The mean age was 15 years ranging from (4.5- 23) years. The site of primary disease was at lower limbs in 43 (78.2%) patients. All patients underwent complete surgical resection of the primary disease with negative margin, 22(51.1%) of the osteosarcoma patients did amputation with tumor necrosis less than 90%. All patients received chemotherapy and only 9 received radiation therapy. The patients were classified into four groups according to time of diagnosis of pulmonary metastasis: at time of diagnosis in 13 (21.8%) patients, within treatment in 16 (30.9%) patients, within first year follow up in 18 (32.7%) patients and detected late in 8 (14.5%) patients. Bilateral lung metastasis diagnosed by CT chest were detected in 42 (76.4%) patients. Size of metastatic nodules was ranging from (0.5 to 10 cm) with mean 3.4 cm. Number of metastatic nodules was ranging from (1 to 28) median 4.Metastatic complications were detected in 19 patients. 5-year OS was 74.8% in the study group, and 68% in osteosarcoma patients. Effect of prognostic factors as sex, time of respectability, laterality, tumor necrosis of the 1ry disease, Timing of lung metastasis, size and site of the primary, Surgical approach of metastatectomy, postoperative complications on overall survival of the studied patients was done with significant P-value of tumor necrosis of the 1ry disease and Timing of lung metastasis 0.017, 0.001 respectively. Conclusion Resection of pulmonary metastases of pediatric solid tumours is a safe and effective treatment that offers better survival.

This study aimed to investigate the effects of nano and organic selenium on ovarian activity, fertility rate, and progesterone hormone levels in Ossimi ewes. Thirty ewes were treated with intra-vaginal sponges impregnated with medroxyprogesterone acetate (40 mg) for 14 d and simultaneously assigned randomly to three groups. The 1st group ewe served as control (CG). Ewes in the 2nd and 3rd groups were treated orally with organic selenium 3 mg/ewe and Nano-selenium 0.2 mg/ewes during intra-vaginal sponges (IVS) treatment SeG and N-SeG, respectively. The ovarian activity was monitored using an ultrasonic device, and serum samples were harvested for progesterone measurement. The results revealed that ewes in SeG and N-SeG groups had a significantly (p

Tomato (Solanum lycopersicon L.) is one of the most widely consumed and produced vegetable crops worldwide. It offers numerous health benefits due to its rich content of many therapeutic elements such as vitamins, carotenoids, and phenolic compounds. Biotic stressors such as bacteria, viruses, fungi, nematodes, and insects cause severe yield losses as well as decreasing fruit quality. Conventional breeding strategies have succeeded in developing resistant genotypes, but these approaches require significant time and effort. The advent of state-of-the-art genome editing technologies, particularly CRISPR/Cas9, provides a rapid and straightforward method for developing high-quality biotic stress-resistant tomato lines. The advantage of genome editing over other approaches is the ability to make precise, minute adjustments without leaving foreign DNA inside the transformed plant. The tomato genome has been precisely modified via CRISPR/Cas9 to induce resistance genes or knock out susceptibility genes, resulting in lines resistant to common bacterial, fungal, and viral diseases. This review provides the recent advances and application of CRISPR/Cas9 in developing tomato lines with resistance to biotic stress.

Abstract Background Early childhood life is critical for optimal development and is the foundation of future well-being. Genetic, sociocultural, and environmental factors are important determinants of child development. Aim The objectives were to screen for suspected developmental delays (DDs) among Egyptian preschool children, and to explore the determinants of these delays based on sociodemographic, epidemiological, maternal, and child perinatal risk factors. Methods A national Egyptian cross-sectional developmental screening of a representative sample of preschool children (21,316 children) aged 12 to 71 months. The Revised Denver Prescreening Developmental Questionnaire (R-PDQ) followed by the Denver Developmental Screening Test, 2nd edition (DDST) was used. Results Each screened child manifested at least one of six developmental categories. Either typical development, gross motor delay (GM), fine motor adaptive delay (FMA), Language delay (L), Personal-social delay (PS), or multiple DDs. The prevalence of preschool children with at least one DD was 6.4%, while 4.5% had multiple DDs. Developmental language delay was the most prevalent, affecting 4.2% of children. The least affected domain was GM (1.9% of children). Boys were more likely to have DD than girls. Children in urban communities were more likely to have at least one DD than those in rural areas (OR = 1.28, 95%CI: 1.14–1.42), and children of middle social class than of low or high social class (OR = 1.49, 95%CI: 1.30–1.70 & OR = 1.40, 95%CI: 1.23–1.59 respectively). The strong perinatal predictors for at least one DD were children with a history of postnatal convulsions (OR = 2.68, 95%CI: 1.97–3.64), low birth weight (OR = 2.06, 95%CI: 1.69–2.52), or history of postnatal cyanosis (OR = 1.77, 95%CI: 1.26–2.49) and mothers had any health problem during pregnancy (OR = 1.73, 95%CI: 1.44–2.07). Higher paternal and maternal education decreased the odds of having any DD by 43% (OR = 0.57, 95% CI: 0.47–0.68) and 31% (OR = 0.69, 95%CI: 0.58–0.82) respectively. Conclusion This study demonstrates a considerable attempt to assess the types and the prevalence of DD among preschool children in Egypt. Perinatal factors are among the most common determinants of DD in preschool children and the majority could be preventable risk factors.

Abstract Background Child disability has significant implications on their well-being and healthcare systems. Aim: This survey aimed to assess the magnitude of seven types of disability among Egyptian children aged 1

We present a simple surgical technique aiming to improve urine outflow through the common urogenital sinus in cloaca and facilitate drainage of existing hydrocolpos. The study included three cases of cloaca with associated hydrocolpos that were operated during the period 2022 through 2023. The patient is placed in the prone position for a standard posterior sagittal anorectoplasty. The distal rectal fistula is severed flush with the vagina/sinus leaving an open defect in the posterior wall of the vagina/sinus. The defect is then widened distally via a vertical incision (∼1 cm) through the posterior wall of the common urogenital sinus toward but not reaching the perineum. This vertical defect is then closed horizontally displacing the posterior vaginal wall downwards toward the perineum (posterior sinuplasty). The postoperative recovery was uneventful in the three cases. Adequate drainage of hydrocolpos was confirmed by imaging at follow-up, as well as improvement of upper urinary tract dilatation. In selected cases of cloaca, posterior sinuplasty is a simple procedure that can be applied during anorectoplasty to provide effective drainage of associated hydrocolpos.

Abstract Background Hepatitis C virus (HCV) infection is considered one of the most urgent health problems in the world, with an incidence of approximately 71 million patients and 399,000 deaths per year from related liver diseases. In this study, we examined the association between 2 single nucleotide polymorphisms (SNPs) in the nucleoside diphosphate kinase 1 (NME1) gene (encoding one of the sofosbuvir metabolizing enzymes) and the response to the sofosbuvir plus daclatasvir regimen in Egyptian HCV-infected patients. Results Our data showed a similarity in the distribution of the CC, CT, and TT genotypes of NME1 rs2302254 C/T (p = 0.847) and the CC, TC, and TT genotypes of NME1 rs16949649 T/C (p = 0.937) among patients who were either treatment responders or relapsers. Based on the univariate and multivariate logistic regression analyses of the significant predictors for sustained virological response (SVR), five factors showed a robust predictive potency for the treatment outcome: age, fasting blood glucose level, platelets, albumin, and alpha-fetoprotein. Strikingly, there was a significant correlation between the rs16949649T/C polymorphism and serum creatinine (p = 0.023). Higher creatinine levels were observed among the CC carriers than the TC or TT carriers. Conclusions The 2 studied SNPs of NME1 had no significant association with SVR in Egyptian HCV-infected patients; however, the noticeable relation between rs16949649T/C and creatinine level might represent a foundation for future studies on the renal extra-hepatic manifestation of HCV and SNPs of NME1 gene.

Abstract Background With the availability of several similar medical devices performing the same function, choosing one for reimbursement is not easy, especially if purchased for a large number of patients. The objective of this project was to create a multicriteria decision analysis (MCDA) tool, that captures and compares all implantable medical devices’ attributes, to provide an objective method for choosing among the available options in Egypt. Method We conducted a systematic review and expert interviews, to identify the relevant criteria for inclusion in the tool. Subsequently, a workshop was conducted, that involved experts in procuring and tendering medical devices. Experts chose the criteria, ranked them, assigned weights and scoring functions for each criterion, and then created the draft tool. A pilot phase followed; then, another workshop was conducted to fine-tune the tool. We readjusted the tool based on experts’ experience with the draft tool. Results The final tool included eight criteria, arranged according to their weightage: technical characteristics (29.4%), country of origin (19.5%), use in reference countries (14.9%), supply reliability (11.7%), previous use in tenders (9.0%), instant replacement within product variety (6.9%), pharmacovigilance (4.6%), and refund or replacement (4.0%). Each medical device was assessed on these eight criteria to achieve a final score, that was compared to the alternative devices’ scores. Price is not included in the MCDA tool, but it will be added in the financial evaluation phase. Conclusion Decisionmakers could use the MCDA tool, to make evidence-based and objective decisions for purchasing implantable devices, in the Egyptian public sector. Post price evaluation, the product with the best value will be chosen for reimbursement. Highlights We created an MCDA tool to help decision makers choose between alternative implantable medical devices in Egypt. The MCDA tool includes eight criteria, where price is evaluated as a separate step. “Technical characteristics” and “country of origin” criteria carried the highest weights, thus representing approximately 50% of the decision.

IntroductionIn 2021, a regional strategy for integrated disease surveillance was adopted by member states of the World Health Organization Eastern Mediterranean Region. But before then, member states including Somalia had made progress in integration of their disease surveillance systems. We report on the progress and experiences of implementing an integrated disease surveillance and response system in Somalia between 2016 and 2023.MethodsWe reviewed 20 operational documents and identified key integrated disease surveillance and response system (IDSRS) actions/processes implemented between 2016 and 2023. We verified these through an anonymized online survey. The survey respondents also assessed Somalia’s IDSRS implementation progress using a standard IDS monitoring framework Finally, we interviewed 8 key informants to explore factors to which the current IDSRS implementation progress is attributed.ResultsBetween 2016 and 2023, 7 key IDSRS actions/processes were implemented including: establishment of high-level commitment; development of a 3-year operational plan; development of a coordination mechanism; configuring the District Health Information Software to support implementation among others. IDSRS implementation progress ranged from 15% for financing to 78% for tools. Reasons for the progress were summarized under 6 thematic areas; understanding frustrations with the current surveillance system; the opportunity occasioned by COVID-19; mainstreaming IDSRS in strategic documents; establishment of an oversight mechanism; staggering implementation of key activities over a reasonable length of time and being flexible about pre-determined timelines.DiscussionFrom 2016 to 2023, Somalia registered significant progress towards implementation of IDSRS. The 15 years of EWARN implementation in Somalia (since 2008) provided a strong foundation for IDSRS implementation. If implemented comprehensively, IDSRS will accelerate country progress toward establishment of IHR core capacities. Sustainable funding is the major challenge towards IDSRS implementation in Somalia. Government and its partners need to exploit feasible options for sustainable investment in integrated disease surveillance and response.

Abstract Objective This study aimed at providing a national prevalence of single and multiple developmental delays (DDs) among 41,640 Egyptian children aged 1 to 12 years and exploring DDs’ associated risk and protective factors. Methods A national household survey from eight governorates of Egypt representing the four major subdivisions of Egypt was conducted through systematic probability proportionate to size. All enrolled children were assessed according to Vineland Adaptive Behavior Scales, (VABS) as a reliable screening questionnaire for identifying categories of DDs that were verified by pediatrics’ specialists. Results The overall prevalence of children with DDs was 6.7%. The prevalence of a single DD was 3.9% versus 2.8% multiple DDs. Communication deficit was the most prevalent type (5.3%). Lower prevalence was identified for fine motor delay (1.0%), gross motor delay, and socialization deficit (1.5% each). Whereas deficits in daily life skills (self-help and adaptive behavior delay) amounted to 2.3%. Living without mothers and/or fathers in homes was associated with increased odds of having DDs by one and a half times (OR = 1.72 and OR = 1.34 respectively). Multiple logistic regression analysis revealed the most predictors for DDs including children who suffer from convulsions after birth (OR = 3.10), low birth weight babies (OR = 1.94), male sex (OR = 1.75), mothers having health problems during pregnancy (OR = 1.70) and belonging to middle socioeconomic status (OR = 1.41). Children who suffered from cyanosis after birth was found to be at risk for any or multiple DDs. Difficult labor was significantly associated with increased odds for multiple DDs (OR = 1.55). Higher paternal and maternal education was associated with decreased odds to have any DDs by 40% (OR = 0.60 and OR = 0.58 respectively). Conclusions The detected prevalence of DDs is within the estimated range of prevalence of DDs for the pediatric population. The majority of the detected risk factors are preventable. Developmental screening is recommended to be implemented in all primary care settings as a routine practice.

IntroductionMelatonin is a neurohormone involving various biological processes, including restoration of cyclicity in animals with seasonal breeding patterns. The use of melatonin in different forms has gained broader acceptance in different species, particularly in summer anestrous buffaloes.ObjectivesThe objective of the current study was to evaluate the melatonin effect on the reproductive and productive performance of crossbred buffaloes during the low breeding season.MethodsSixty-five cyclic and reproductively sound crossbred buffaloes were randomly allocated to three groups: the G1 (n = 20) served as the control group and received no single melatonin, G2 received melatonin (n = 22; 18 mg/50 kg, body weight) once prior to synchronization and G3 group was administered multiple melatonin injections (n = 23; 6 mg/50 kg body weight) for three consecutive days before the start of the synchronization protocol. The reproductive performance, milk yield traits, and serum immunoglobulin M (IgM) and melatonin levels were evaluated in treated and untreated crossbred buffaloes.ResultsThe results revealed that a single dose of melatonin administration has (p

Rice production faces challenges related to diverse climate change processes. Heat stress combined with low humidity, water scarcity, and salinity are the foremost threats in its cultivation. The present investigation aimed at identifying the most resilient rice genotypes with yield stability to cope with the current waves of climate change. A total of 34 rice genotypes were exposed to multilocation trials. These locations had different environmental conditions, mainly normal, heat stress with low humidity, and salinity-affected soils. The genotypes were assessed for their yield stability under these conditions. The newly developed metan package of R-studio was employed to perform additive main effects and multiplicative interactions modelling and genotype-by-environment modelling. The results indicated that there were highly significant differences among the tested genotypes and environments. The main effects of the environments accounted for the largest portion of the total yield sum of squared deviations, while different sets of genotypes showed good performance in different environments. AMMI1 and GGE biplots confirmed that Giza179 was the highest-yielding genotype, whereas Giza178 was considered the most-adopted and highest-yielding genotype across environments. These findings were further confirmed by the which–won–where analysis, which explained that Giza178 has the greatest adaptability to the different climatic conditions under study. While Giza179 was the best under normal environments, N22 recorded the uppermost values under heat stress coupled with low humidity, and GZ1968-S-5-4 manifested superior performance regarding salinity-affected soils. Giza 177 was implicated regarding harsh environments. The mean vs. stability-based rankings indicated that the highest-ranked genotypes were Giza179 > Giza178 > IET1444 > IR65600-77 > GZ1968-S-5-4 > N22 > IR11L236 > IR12G3213. Among them, Giza178, IR65600-77, and IR12G3213 were the most stable genotypes. Furthermore, these results were confirmed by cluster-analysis-based stability indices. A significant and positive correlation was detected between the overall yield under all the environments with panicle length, number of panicles per plant, and thousand grain weight. Our study sheds light on the notion that the Indica/Japonica and Indica types have greater stability potential over the Japonica ones, as well as the potential utilization of genotypes with wide adaptability, stability, and high yield, such as Giza178, in the breeding programs for climate change resilience in rice.

The present study investigated the effects of epidermal growth factors (EGF) and/or β-Mercaptoethanol (βME) supplementations to oocyte maturation, fertilization, and culture media on the buffalo in vitro embryo production. The ovaries were collected and transferred within 2 h to the laboratory. The cumulus oocytes complexes were aspirated from 3 to 8 mm diameter follicles. Firstly, EGF; 0, 10, 20, or 50 ng/mL or βME; 0, 25, 50, 100, or 200 μM were supplemented to the in vitro maturation (TCM-199), fertilization (IVF-TALP), or culture (IVC: SOF) media. Our results revealed that supplementing EGF (20 ng/mL) to the TCM-199, IVF-TALP, or SOF media could efficiently improve the growth rates and development of buffalos' embryos, while EGF (50 ng/mL) could stimulate the embryo production only after treatment of the IVF-TALP /or SOF media, but not the IVM medium. However, βME was less efficient than EGF; it stimulated the growth rates of buffalo embryos when supplemented with the maturation and fertilization (IVF-TALP) media in a 50 μM concentration. Secondly, combined EGF (20 ng/mL) and βME (50 μM) were supplemented to the maturation media as effective concentration. The combined treatment of EGF (20 ng/mL) and βME (50 μM) showed no significant enhancing effect on the buffalo embryos compared to each alone. For future perspectives, further study is required to examine the effects of combined EGF and βME on the maturation and fertilization of buffalo oocytes at different categories of age and seasonal localities.

IntroductionFollowing the application of different artificial insemination and synchronization protocols, the synchronized buffaloes had a higher incidence of early embryonic or fetal death, thus impairing reproductive performance. Therefore, there is a need to devise a synchronizing program that can improve conception, allow early pregnancy diagnosis, reduce early embryonic losses, and provide an early clue for pregnancy diagnosis and establishment. The present study aimed (1) to determine the effect of administration of different GnRH doses at day 20 of artificial insemination (AI) on the reproductive performance of buffaloes and (2) to observe the influence of synchronization protocol, parity, age, milk production, and body condition score (BCS) on early embryonic loss and progesterone (P4) levels in crossbred buffaloes.MethodsCrossbred buffaloes (n = 101) were synchronized using the GPGMH protocol. At day 20 of AI, the synchronized buffaloes were randomly divided into four groups and administrated GnRH doses (0, 100, 150, and 200 μg). The buffaloes were monitored for ovarian dynamics, P4 level, non-return rate, embryonic/fetal losses, and pregnancy rates. The previously synchronized buffaloes were also classified for synchronization protocol (with or without GnRH), parity (nulli- or multiparous), milk production (high or low), BCS (low, medium, or good) or age (>3 or < 3 years) groups for observing the embryonic loss and P4 level variations.ResultsThe results indicated no difference (P > 0.05) in CL size, P4 level, pregnancy rate and embryo/fetal losses across the treatment groups at different observation periods. There was a high (P < 0.05) incidence of early embryonic mortality in aged, multiparous, low BCS and low milk-producing buffaloes treated without GnRH.ConclusionThe data suggest that GnRH 200 μg at day 20 of AI improves embryo survival and pregnancy maintenance in crossbred buffaloes.

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.

Background. Type 4 osteoporotic fracture (OF4), according to the classification system of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU), is unstable and requires fixation as per the guidelines of the same group. We evaluated the use of stand-alone vertebral body augmentation (VBA) in pain control of OF4. Methods. This is a single-centre, in two hospitals, comparative study to evaluate the effectiveness of percutaneous vertebroplasty (PVP) and kyphoplasty (KP) in pain control of OF4. OF4 patients treated with VBA were compared to a conservatively treated control group. The two groups of OF4 were then compared to similar cohort of OF2 and OF3 patients who were treated by either VBA or expectantly. Results. A total of 78 cases were studied. VBA of OF4 showed a statistically significant better pain control than conservative treatment. The response of this group of fractures to VBA was similar to that of OF2 and 3. Conclusion. VBA can provide satisfactory pain control for OF4 patients.

The study objective was to evaluate Allium sativum's potential and Nigella Sativa's combination's potential to reduce aluminum toxicity and return to the normal state. In the present study, a hundred albino rats were randomly divided into five equal groups. The first group was used as a control group; the other four groups were exposed to aluminum 1,600 ppm. The second exposed to aluminum only; the third and fourth groups were treated with Allium sativum 5% and Nigella sativa 5%, respectively, while the fifth group was treated with a mix of Allium sativum 2.5% and Nigella sativa 2.5% for 8th weeks. After 8 weeks, the aluminum administration was stopped, and the second group was divided into three groups. The groups were treated with Allium sativum 5% and Nigella sativa 5%, and a mix of Allium sativum 2.5% and Nigella sativa 2.5%, respectively. The first group was the control group (continued from the first experiment). Garlic and Nigella sativa were crushed and added to feed while receiving aluminum chloride daily at a dose of 1.6 ml/l was added to the drinking water. Histopathological changes in the liver, kidney, and testes were investigated after 8 and 16 weeks, and blood samples were collected after 4, 8, and 16 weeks for biochemical blood parameters. The results showed that the histopathological examination of the liver, kidney, and testes showed signs of congestion in blood vessels after aluminum exposure. Meanwhile, the treatment with Allium sativum or Nigella sativum or the mixture between them had positive effects on evading the harmful effects of aluminum in the liver, Kidney, and testes tissues. In addition, there were protective effects for Allium sativum and Nigella sativa against aluminum on serum creatinine, urea, ALT, and AST concentrations. The present study concluded that supplementation with Allium sativum or Nigella sativa or their combination could reduce aluminum toxicity and return the liver, kidney, and testes to normal.

The present study aims to evaluate the effects of prepartum maternal supplementation of Capsicum oleoresin (CAP) on colostrum quality and growth performance in newborn buffalo calves. Twelve multiparous buffaloes were randomly assigned to two groups starting from 4 weeks prepartum: the control group with a basal diet (CON) and the treatment group with a basal diet supplemented with 20 mg CAP/kg dry matter (CAP20). After birth, all calves were weighed and received colostrum from their respective dam directly within 2 h. After that, calves received pasteurized milk and starter feed till 56 days of age. The results showed that CAP increased lactose (P < 0.05) in colostrum, and it tended to increase monounsaturated fatty acids; however, it decreased colostrum urea nitrogen (P < 0.10). CAP did not affect colostrum yield and immunoglobulin G and M concentrations. The weekly starter intake was not affected by maternal CAP supplementation during the first 6 weeks of life. There was an increasing tendency in weekly starter intake from weeks 7 and 8 (P < 0.10) in CAP20 compared with CON. At 7 days of age, calves in CAP20 had higher immunoglobulin G (P < 0.05) and a decreased tendency in calves' serum glucose compared with CON. Additionally, maternal CAP supplementation increased calves' serum β-hydroxybutyric acid (P < 0.05) and tended to increase total protein (P < 0.10), while decreased non-esterified fatty acids (P < 0.05) at 56 days of age. Calves in CAP20 had higher final withers height, final heart girth, average withers height, and average heart girth than the CON (P < 0.05). These results suggest that maternal CAP supplementation could improve colostrum quality and positively affect the performance of buffalo calves.

This study aimed to determine the effect of capsicum oleoresin (CAP) on rumen fermentation and microbial abundance under different temperature and dietary conditions in vitro. The experimental design was arranged in a 2 × 2 × 3 factorial format together with two temperatures (normal: 39°C; hyperthermal: 42°C), two forage/concentrate ratios (30:70; 70:30), and two CAP concentrations in the incubation fluid at 20 and 200 mg/L with a control group. Regarding the fermentation characteristics, high temperature reduced short-chain fatty acids (SCFA) production except for molar percentages of butyrate while increasing acetate-to-propionate ratio and ammonia concentration. The diets increased total SCFA, propionate, and ammonia concentrations while decreasing acetate percentage and acetate-to-propionate ratio. CAP reduced acetate percentage and acetate-to-propionate ratio. Under hyperthermal condition, CAP could reduce acetate percentage and increase acetate-to-propionate ratio, lessening the negative effect of high heat on SCFA. Hyperthermal condition and diet altered the relative abundance of microbial abundance in cellulose-degrading bacteria. CAP showed little effect on the microbial abundance which only increased Butyrivibrio fibrisolvens. Thus, CAP could improve rumen fermentation under different conditions, with plasticity in response to the ramp of different temperature and dietary conditions, although hardly affecting rumen microbial abundance.

Abstract Background Retraction is necessary to access deep areas in the brain and skull base, but prolonged and forceful use of fixed retraction might be injurious. Several techniques were developed, in the concept of minimally invasive neurosurgery, to eliminate or minimize the use of fixed retractors. The authors discuss the technical considerations and limits in applying dynamic retraction in brain surgery for a variety of lesions using different approaches. Results We retrospectively collected 123 cases with brain lesions in diverse locations, were dynamic retraction, using the tools in the operator hands and was achieved successfully instead of fixed retraction. Cases with aneurysms were excluded, although retraction was applied during clipping only. Superficial and large masses that do not require fixed retraction as a routine were excluded also. We relied mainly on patient positioning to benefit from the gravity, proper design of the craniotomy, arachnoid dissection, cerebrospinal fluid aspiration, and internal decompression of the mass when possible. Different approaches for different lesions were utilized in our patients, subfrontal or pterional and their modifications in 45.5% of cases, suboccipital in 21.1%, retrosigmoid in 13%, the interhemispheric approach in 10.5%, transcortical to lateral ventricles in 7.3%, and posterior subtemporal in 2.4%. Dynamic retraction with the surgical tools was used successfully in all cases except 7 patients (5.6%) where we had to use fixed retraction transiently. Conclusion Several considerations are helpful and amenable to achieve successful brain surgery without fixed retraction. Utilizing the gravity, unlocking of the brain, choosing the surgical corridor, cerebrospinal fluid suctioning, and mastering of the microsurgical techniques are the keys.

Polyunsaturated fatty acids (PUFAs) constitute a significant lipid class with essential nutritional and health benefits for both animal and human health; however, their effect and interaction with the gut microbiota ecosystem are still unclear. Therefore, the present study aims to investigate the effect of fish oil (FO) on ruminal fermentation and bacterial abundance under high- and low-forage diets. Thirty-six ruminal fluid samples were allocated into two experiments. The first was on high-forage diet and included three groups: the control (basal diet with 70% forage and 30% concentrate), group 2 (basal diet + 5 mL/L FO), and group 3 (basal diet + 10 mL/L). The second experiment was on low-forage diet: the control (basal diet with 30% forage and 70% concentrate), group 2 (basal diet + 5 mL/L FO), and group 3 (basal diet + 10 mL/L). The results showed that although FO supplementation did not affect the pH level among different diets, it significantly decreased methane under a high-forage diet. In addition, regarding the fatty acids profile, FO supplementation in high-forage diet significantly decreased fatty acids in both; however, under a low-forage diet, FO groups showed significantly higher fatty acid content than the control. However, FO supplementation increased the abundance of Anaerovibirio, Selenomonas, pseudobutyrivibrio, and butyrivibrio through a high-forage diet. In contrast, the abundance of Prevotella, Rikenellaceae RC9 gut group, and Saccharofermentans was depressed with FO supplementation. Whereas under low-forage diet, FO supplementation increased Ruminobacter, Anaerovibirio, Megasphaera, Pseudobutyrivibrio, Streptococcus, Butyrivibrio, unclassified_lachnospiraceae; it also decreased Prevotella and Rikenellaceae RC9 abundance similar to the high-forage diet. Based on the KEGG pathway results, FO supplementation significantly downregulated genes mainly related to folding, sorting and degradation, environmental adaptation, cell motility, transcription, membrane transport, and signal transduction. The results revealed that FO has a depressing effect on ruminal fermentation and some bacterial population; however, this negative effect can be minimized in high-concentrate diets.

Abstract Introduction Spheno-orbital meningiomas are characterized by bone invasion with extensive hyperostosis and possible encroachment into the orbit, infra-temporal fossa, and/or the cavernous sinus that render total surgical excision challenging. The surgical technique utilized is a key factor facilitating complete resection and hence improvement of proptosis and accompanying visual symptoms. Methods This is a retrospective study of twenty-two patients (including 4 recurrent cases) with meningioma en-plaque, presenting with hyperostosis and proptosis. We describe the surgical approaches used, technique, and extent of resection in addition to postoperative outcome. Results In twenty patients, the pterional approach was used, while two patients were operated on via the mini orbito-zygomatic approach. Total resection of the tumor was achieved in 10 cases (45.5%), subtotal in 6 (27.3%), partial in 5 (22.7%), and in 1 case, injury to the internal carotid artery lead to premature termination of surgery. Seventeen patients (77.3%) had improvement of proptosis, 2 (9.1%) had partial improvement, and 2 (9.1%) had no improvement at 3 months of follow-up. Post-operative morbidities include cerebrospinal fluid leak, infection, and hydrocephalus, each occurred in one (4.5%) different case. Conclusions Proper drilling of the lateral and superior orbital walls with excision of any intra-orbital soft tissue components is all key points for better surgical resection and clinical regression of proptosis. However, factors such as extension of the hyperostosis to the infra-temporal fossa or medial orbital wall, tumor invasion of the cavernous sinus, or adherence of tumor to the orbital muscles, prevent total excision.

The recent increase in demand for animal protein sources has led to the urgency to introduce non-conventional feed sources and opened the space to study feed management and its effects on animal productivity. Forage rape (Brassica napus L.) is a high-quality forage crop with a remarkable nutritional value and productive and fast growth capacity; however, studies on processing methods are limited. This study evaluates the effect of an ensiling process on rape silage quality kinetics, in situ degradability, and milk responses in dairy buffaloes. Firstly, the whole-plant forage rape was ensiled, and silage samples were collected 30, 60, and 90 days after ensiling to determine pH, evaluation of sensory characteristics, and chemical composition. Then, samples were taken for further chemical analysis at days 30, 60, and 90. After that, the degradability of the dry matter (DM) and crude protein (CP) of the silage was evaluated by an in situ degradability experiment using three fistulated buffalos (550 ± 20 kg body weight, 4.7 ± 0.76 years). Finally, whole-plant rape silage (after 60 days) was included in a 10, 20, and 30% of DM dairy buffalo diet in the lactating buffalo ration. The results showed that silage pH did not change significantly during the ensiling process (p > 0.05); however, the silage achieved the optimal comprehensive sensory characteristic score from days 30 to 60. There was also a significant change in neutral detergent fiber (NDF) content and acid detergent fiber content, which decreased significantly (p = 0.001 and p < 0.001, respectively). Ensiling of the whole-plant rape significantly reduced effective DM degradability (p < 0.05) without altering CP degradability (p > 0.05). Furthermore, the inclusion of forage rape silage linearly (p = 0.03) increased milk fat and protein contents and did not affect milk yield, lactose, and urea nitrogen contents in raw buffalo milk. In conclusion, whole-plant rape silage could significantly maintain the optimal ether extract (EE) protein content without affecting CP degradability, in addition to improving milk fat and milk protein. Therefore, ensiling may be an efficient method of forage rape utilization, and forage rape silage can be recommended as a good forage source for dairy buffaloes.

Abstract Background The cause of pyeloplasty failure remains unclear; therefore, increasing interest has been directed to identify the reason for dissatisfactory surgical results. Some studies attempted to investigate the role of the histopathological pattern. The aim of the work is to study the correlation between the histopathological pattern of obstructed pelviureteric junction (PUJ) segment and the outcome of pyeloplasty in children with the PUJ. Methods Fifty-four patients with pelviureteric junction obstruction (PUJO) were included in the study; patients were evaluated preoperative. All patients were operated by the same surgeon using Anderson–Hynes pyeloplasty; the resected obstructed PUJ segment examined histopathological using light microscope and image analyzer system to identify mean renal pelvis smooth muscle thickness (mRPSMT), collagen-to-smooth muscle ratio and elastin content. Results The study includes 50 patients with mean age Mean 24.48 ± 15.3 months. Two patients show no improvement, while 24 improved at 3 months, 16 improved at 6 months, and 8 improved at 12 months. mRPSMT showed significant difference between improvement groups (136.02 ± 44.4, 173.47 ± 49.69 and 258.56 ± 96.82 μm), while elastin content or collagen-to-smooth muscle ratio showed no significant difference. Conclusions Our data showed a clear relationship between mRPSMT and the time over which radiological improvement occurs; increase in mRPSMT is associated with a delay in postoperative radiological improvement time. We found no relation between elastin content nor collagen-to-smooth muscle thickness and postoperative improvement course.

Abstract Background Umbilical hernia (UH) is one of the most common problems seen by paediatric surgeons. The recurrence rate after surgical repair is 1–2%. In this study, we examined the ring of umbilical hernia histologically to detect differences between the two types of umbilical hernia and the relation between this histologic difference and the technique of surgical repair. Results Fifty paediatric patients of both sexes with clinically diagnosed direct and indirect (oblique) umbilical hernia were collected from the paediatric surgery department in the period between March 2016 and February 2018. Age ranged between 2 and 5 years. Biopsies (5 mm) were taken from the upper, lower, right and left borders of the ring in both types and processed for histological examination. Classification of umbilical hernia was based on Chang-Seok et al.’s classification, which classified the umbilical hernia into three types (direct, oblique and hernia into umbilical cord) which depend on the presence of a hole in the ring and whether the ring is covered by ligamentum teres or not. Histological sections were examined by light microscopy, and data was analysed using chi-square test to detect predominance of one type of collagen fibre over the other in each sample. Transverse collagen fibres were predominant in the upper border of the ring in 15 patients (75%) and the lower border in 14 patients (70%) of direct umbilical hernia. Transverse collagen fibres were also predominant in the right border of the ring in 21 patients (70%) and the left border in 21 patients (70%) of indirect umbilical hernia. This predominance in both cases was found to be statistically significant. Conclusions Predominance of transverse collagen fibres in the upper and lower borders of the ring in direct umbilical hernia and predominance in the right and left borders of the ring in oblique umbilical hernia encouraged us to suggest that wound will be more stable if closed in a transverse manner in direct umbilical hernia and a longitudinal manner in oblique umbilical hernia especially in recurrent cases.

Abstract Background Provision of emergency obstetric care is considered the key for maternal mortality reduction worldwide. This study evaluated the impact of community- and facility-based educational programs on provision of emergency obstetric care in Egypt. The study focused on evaluating utilization of the available health services and care seeking behaviors of mothers in the childbearing period. Methods We implemented a package of community- and facility-focused educational interventions in two of Egypt’s lowest income governorates. At facility level, health professionals at rural health units from 21 villages over 5 years were trained. Mass media gathering, individual teaching at health facilities, printed materials and home-based care sessions were provided. Collectively, these interventions were designed to focusing on recognition of the early warning signs during pregnancy, delivery and postpartum period for timely referral to hospitals for 20,494 women and adolescents mothers. Results The impact of the interventions was highly reflected on the percent of mothers received care during their pregnancy period. Proper antenatal care at governmental or private health facilities was raised dramatically from 0.6 to 59.3% and those who utilized at least one family planning method from 61.4 to 74.4%. Accordingly, the rate of complications significantly reduced during pregnancy (38.1 to 15.1%), during delivery (24.1 to 13.1%) and during postpartum (81.7 to 7.0%). As an impact to the improvement, there was a marked reduction in adolescent pregnancy by 55% and better birth outcome with a reduction in the percent of stillbirth by 11.5%. Conclusion It is important to provide a comprehensive package that works at both improving qualities of care as well as empowering women by knowledge to first aid measures at the community level. The cost-effective way to empower mothers to provide first aid measures as emergency obstetric care is to adopt the outreach approach which could be more influential than mass media campaigns for the at-risk and vulnerable and low-income communities.

Abstract Background Meningioma arising from locations in the vicinity of the optic nerve or chiasm may affect the visual function and sometimes the presentation of such tumors. Decompression of the optic nerve or chiasm can give a chance for the visual function to recover. Methods Thirty patients who had visual function affection and underwent meningioma excision are followed up for a period of 1 year with regular follow of their visual function periodically. Results In this study, females were more prevalent than males, 24 out of 30, age ranged from 24 to 72 years at the time of surgery, half the patients (15) presented with visual deterioration, the other patients presented with headache, seizure, proptosis, or accidentally discovered. Twenty-two patients improved concerning their visual function over time, 6 patients had a stationary course, and 2 patients deteriorated postoperatively. Conclusion Follow-up of patients after surgical excision of meningioma compressing the anterior optic pathway showed gradual improvement in vision in follow-up period up to 1 year, although the improvement in visual function showed a surge in early postoperative period, with continuous less steep improvement afterwards till the end of the observation period. Surgical excision of meningiomas compressing the anterior visual pathway gives chance for recovery of visual function, more in younger patients, patients with a shorter period of visual deterioration, and patients with mild affection of the preoperative visual status. No statistically significant influence of tumor site, size, degree of excision, and surgical approach on the postoperative visual outcome in this series.

Abstract Background Organ donation has become one of the most effective ways to save lives and improve the quality of life for patients with end-stage organ failure. No previous studies have investigated the preferences for the different consenting options for organ donation in Egypt. This study aims to assess Egyptians’ preferences regarding consenting options for posthumous organ donation, and measure their awareness and acceptance of the Egyptian law articles regulating organ donation. Methods A cross sectional study was conducted among 2743 participants over two years. Each participant was required to rank eleven consenting options from 1 (most preferred) to 11 (least preferred), and to report his awareness and acceptance of the seven articles of the Egyptian law of organ donation. Results 47% of the participants expressed willingness to donate their organs after death. This percentage increased to 78% when consenting options were explained to participants. “Informed consent by donor only” was the most preferred type of consent for one third of respondents. Awareness of the law articles regulating organ donation was relatively low ranging from 56% to 23%. Conclusion Currently, around half of the Egyptian population agree to posthumous organ donation. This percentage could be increased significantly by raising the awareness about how the process of donation could be regulated and how the patient’s right of decision could be protected.

In 2017, the blockade of Qatar Gulf states caused a plethora of effects on the country. This paper sought to examine the resulting threat effects of this blockade in terms of lowered self-esteem and well-being, and the potential buffering effects of an overarching identity. Using self-report questionnaire data from Qatari secondary school students (N = 1,410), multiple moderated mediation models investigated the predictive effects of youngsters’ perceived threat, via self-esteem, on their well-being, and the mitigating roles herein of, respectively, national, Gulf region, and Arab identity. Perceived threat was indeed related to lower well-being via lower self-esteem, and this relationship was equally strong for those low and high in social identity. In terms of the three facets of identity, the overarching Gulf identity seems the most predictive, and it even (marginally significantly) buffers the negative relationship between threat and reduced self-esteem.

Management of aspirated foreign body in children is challenging. In situations when the incidence is not witnessed, the diagnosis is delayed which results in later complications. When neglected, the diagnosis becomes eluding as the presentation mimics other chest pathologies. Overlooked foreign bodies result in serious complications such as lung abscess and pyothorax. Migration of aspirated foreign bodies is reported. Empyema complicating a neglected foreign body was reported once in adults but not in pediatric population. We present a case of a child with pyothorax. Intraoperatively, an intrathoracic leaf was found to be the cause.

Multiplex genome-editing (MGE) technologies are recently developed versatile bioengineering tools for modifying two or more specific DNA loci in a genome with high precision. These genome-editing tools have greatly increased the feasibility of introducing desired changes at multiple nucleotide levels into a target genome. In particular, clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein (Cas) [CRISPR/Cas] system-based MGE tools allow the simultaneous generation of direct mutations precisely at multiple loci in a gene or multiple genes. MGE is enhancing the field of plant molecular biology and providing capabilities for revolutionizing modern crop-breeding methods as it was virtually impossible to edit genomes so precisely at the single base-pair level with prior genome-editing tools, such as zinc-finger nucleases (ZFNs) and transcription activator-like effector nucleases (TALENs). Recently, researchers have not only started using MGE tools to advance genome-editing applications in certain plant science fields but also have attempted to decipher and answer basic questions related to plant biology. In this review, we discuss the current progress that has been made toward the development and utilization of MGE tools with an emphasis on the improvements in plant biology after the discovery of CRISPR/Cas9. Furthermore, the most recent advancements involving CRISPR/Cas applications for editing multiple loci or genes are described. Finally, insights into the strengths and importance of MGE technology in advancing crop-improvement programs are presented.

Abstract Purpose We aim to summarize the role of surgical treatment of spontaneous basal ganglionic hemorrhage based on prospective analysis of our patients and determine the factors that favor the outcome. Methods A prospective analysis was done of 66 patients from January 2014 to June 2017. Inclusion criteria for the patients in this study were as follows: patients aged between 15 and 60 years; CT scan showed basal ganglionic hematoma with or without intraventricular extension within 24 h post ictus; hematoma volume was Glasgow Coma Scale (GCS) scores ≥ 5, and stable vital signs. Surgical techniques are open craniotomy. Results A total of 66 patients underwent surgical intervention consisting of 47 (71.2%) men and 19 (28.8%) women. Their age varies from 15 to 60 with mean age ± SD (range) 46.53 ± 13.24 (18.0–60.0). According to GCS, patients were categorized into three groups: GCS 5–8, 21 (31.8%) patients; GCS 9–12, 30 (45.5%) patients; and GCS 13–15, 15 (22.7%) patients. The favorable outcome group was slightly younger (p value 0.050*). Also, the volume and extension of hematoma into the ventricular system, hydrocephalic dilatation, and midline shift greater than 5 mm had a significantly worse outcome with statistically significant difference. Conclusion The early surgical management with removal of the hematoma led to dramatic reduction of ICP and improved the prognosis. Patients with signs of brain herniation, a midline shift > 5 mm, hydrocephalic dilatation, ventricular hemorrhage, and a depressed level of consciousness have a poor prognosis. Trial registration 17300234 registered 9/2018

Resumen: Introducción: Se ha sugerido que las alteraciones en las hormonas tiroideas ocurridas en pacientes con enfermedad crítica, fenómeno conocido como síndrome del enfermo eutiroideo (SEE), pueden tener valor pronóstico. No obstante, los datos en población pediátrica son escasos. El objetivo del estudio fue evaluar la prevalencia y el valor pronóstico del SEE en niños críticos. Materiales y métodos: Estudio prospectivo observacional en 70 niños críticos ingresados en la unidad de cuidados intensivos pediátricos (UCIP). Se determinaron los niveles de triyodotironina libre (T3L), tiroxina libre (T4L) y tirotropina (TSH) en las primeras 24 horas de ingreso. La variable de resultado principal fue la mortalidad a los 30 días. Resultados: Se observó SEE en el 62,9% de los pacientes, aunque adoptó formas diversas. El patrón más frecuente fue un nivel bajo de T3L con niveles normales de T4L y TSH (25,7% de los pacientes). La combinación de valores bajos de T3L, T4L, y TSH ocurrió en el 7,1% de los pacientes. Hubo un hallazgo inusual de TSH elevada en 3 pacientes que podría estar asociado a la gravedad de la enfermedad. Los valores bajos de T4L se observaron con una frecuencia significativamente mayor en pacientes fallecidos en comparación con supervivientes (50% versus 19,2%, p = 0,028). El SEE predijo la mortalidad de manera independiente (OR = 3,91; IC 95% = 1,006-15,19; p = 0,0491). La combinación de niveles bajos de T3L, T4L, y TSH fue el mejor factor pronóstico independiente de mortalidad (OR = 16,9; IC 95% = 1,40-203,04; p = 0,026). Se observó una correlación negativa entre la TSH y la duración de la estancia en la UCIP (rs = —0,35; p = 0,011). El valor de T3L fue significativamente menor en pacientes tratados con perfusión de dopamina, comparados con pacientes que no la recibieron (2,1 ± 0,66 versus 2,76 ± 0,91 pg/ml, p = 0,011). Conclusión: El SEE es común en niños críticos y parece estar asociado a la mortalidad y la gravedad de la enfermedad. Abstract: Introduction: Alterations in thyroid hormones during critical illness, known as non-thyroidal illness syndrome (NTIS), were suggested to have a prognostic value. However, pediatric data is limited. The aim of this study was to assess prevalence and prognostic value of NTIS among critically ill children. Materials and methods: A prospective observational study conducted on 70 critically ill children admitted into pediatric intensive care unit (PICU). Free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) were measured within 24 hours of PICU admission. Primary outcome was 30-day mortality. Results: NTIS occurred in 62.9% of patients but it took several forms. The most common pattern was low FT3 with normal FT4 and TSH (25.7% of patients). Combined decrease in FT3, FT4, and TSH levels occurred in 7.1% of patients. An unusual finding of elevated TSH was noted in three patients, which might be related to disease severity. Low FT4 was significantly more prevalent among non-survivors compared with survivors (50% versus 19.2%, P = .028). NTIS independently predicted mortality (OR = 3.91; 95% CI = 1.006-15.19; P = .0491). Concomitant decrease in FT3, FT4, and TSH was the best independent predictor of mortality (OR = 16.9; 95% CI = 1.40-203.04; P = .026). TSH was negatively correlated with length of PICU stay (rs = —0.35, P = .011). FT3 level was significantly lower among patients who received dopamine infusion compared with those who did not receive it (2.1 ± 0.66 versus 2.76 ± 0.91 pg/mL, P = .011). Conclusion: NTIS is common among critically ill children and appears to be associated with mortality and illness severity.