Fosfomycin Therapy for Non-Complicated Lower Urinary Tract Infections during Pregnancy: Tanta University Experience

Objectives: To evaluate the efficacy, compliance, safety and economic cost for Fosfomycin trometamol and Nitofurantoin in uncomplicated lower urinary tract infections during pregnancy. Background: Nitofurantoin and Fosfomycin trometamol are recommended as the first-line agents for treatment of urinary tract infections (UTIs) in the latest guidelines endorsed by the Infectious Diseases Society of America (IDSA) and the European Society for Clinical Microbiology and Infectious Diseases (ESCMID). Fosfomycin is bactericidal and inhibits bacterial cell wall biogenesis and reduces bacterial adherence to uroepithelial cells. Fosfomycin has broad antibacterial activity against both Gram-positive and Gram-negative pathogens, as Escherichia coli, Escherichia faecalis, and various Gram-negatives like Citrobacter and Proteus. Both Nitofurantoin and Fosfomycin are category B in pregnancy. Patients and Methods: This study was conducted at Tanta University Hospitals in the period from June, 1, 2015 to January, 1, 2017. Patients were recruited from outpatient clinics of Obstetrics and Gynecology and Urology Departments presenting with asymptomatic bacteruria or cystitis. Patients were allocated randomly into 2 groups: group I (n = 50 cases) received Fosfomycin therapy and group II (n = 50 cases) received Nitofurantoin therapy (n = 50 cases). After treatment, evaluation of patient symptoms, organism count, patient compliance and cost of treatment were done. Results: The enrolled patients were suffering from lower urinary tract infections;asymptomatic bacteruria (17 cases) or cystitis (83 cases). Ten patients were excluded. The demographic data of included patients were not significant for both groups. Complete relief (100%) of symptoms 5 days after start of treatment was noticed in Fosfomycin group while improvement of symptoms after 5 day-treatment was noticed in 86.49% in Nitofurantoin group (p-value = 0.030). The side effects were recorded in 7 cases (18.42%) in Fosfomycin group compared to (35.14%) with significant difference in the reported side effects, (p-value = 0.003). Compliance was 38/38 (100%) in Fosfomycin group compared to 34/37 (91.89%) in Nitrofuantoin group (p-value = 0.001). Resistance was very minimal in Fosfomycin group where 1/38 case (2.63%) reported resistance for treatment compared to 8/37 cases (21.62%) in Nitofurantoin group (p-value = 0.001). Conclusion: Fosfomycin trometamine proved to be safe, effective, and has limited resistance. Moreover higher patient compliance and fewer side effects were recommending Fosfomycin to be a first choice drug for uncomplicated lower urinary tract infections during pregnancy at Tanta University.

跟网型和构网型逆变器的阻抗无源化方法综述

相比传统同步机主导的电力系统,由并网逆变器所主导的新能源并网发电系统动态特性发生了根本性变化。近年,国内外报道了多次新能源并网发电系统振荡事件,振荡现象具有宽频域特征,动态行为具有非线性、时变性和复杂性。并网逆变器的端口阻抗无源性是保证并网发电系统稳定的充分条件,适用于复杂电网下的稳定性优化。文中针对跟网型和构网型逆变器,分别从控制器优化设计、串并联虚拟阻抗和其他无源化方法这三个方面,对两类逆变器的中高频阻抗无源化改善方法进行了总结和梳理,最后探讨了当前研究的不足与现存的挑战。

Assessment of plant diversity of endemic species of the Saharo-Arabian region in Egypt

Savanna,semi-deserts,and hot deserts characterize the Saharo-Arabian region,which includes Morocco,Mauretania,Algeria,Tunisia,Libya,Egypt,Palestine,Kuwait,Saudi Arabia,Qatar,Bahrain,the United Arab Emirates,Oman,Yemen,southern Jordan,Syria,Iraq,Iran,Afghanistan,Pakistan,and northern India.Its neighboring regions,the Sudano-Zambezian region belonging to the Paleotropical Kingdom and the Mediterranean and Irano-Turanian regions included in the Holarctic Kingdom,share a large portion of their flora with the Saharo-Arabian region.Despite the widespread acknowledgment of the region's global importance for plant diversity,an up to date list of the Saharo-Arabian endemics is still unavailable.The available data are frequently insufficient or out of date at both the whole global and the national scales.Therefore,the present study aims at screening and verifying the Saharo-Arabian endemic plants and determining the phytogeographical distribution of these taxa in the Egyptian flora.Hence,a preliminary list of 429 Saharo-Arabian endemic plants in Egypt was compiled from the available literature.Indeed,by excluding the species that were recorded in any countries or regions outside the Saharo-Arabian region based on different literature,database reviews,and websites,the present study has reduced this number to 126 taxa belonging to 87 genera and 37 families.Regarding the national geographic distribution,South Sinai is the richest region with 83 endemic species compared with other eight phytogeographic regions in Egypt,followed by the Isthmic Desert(the middle of Sinai Peninsula,53 taxa).Sahara regional subzone(SS1)distributes all the 126 endemic species,Arabian regional subzone(SS2)owns 79 taxa,and Nubo-Sindian subzone(SS3)distributes only 14 endemics.Seven groups were recognized at the fourth level of classification as a result of the application of the two-way indicator species analysis(TWINSPAN)to the Saharo-Arabian endemic species in Egypt,i.e.,I Asphodelus refractus group,II Agathophora alopecuroides var.papillosa group,III Anvillea garcinii group,IV Reseda muricata group,V Agathophora alopecuroides var.alopecuroides group,VI Scrophularia deserti group,and VII Astragalus schimperi group.It's crucial to clearly define the Saharo-Arabian endemics and illustrate an updated verified database of these taxa for a given territory for providing future management plans that support the conservation and sustainable use of these valuable species under current thought-provoking devastating impacts of rapid anthropogenic and climate change in this region.

Surface activation of viscose textiles via air,argon,and oxygen dielectric barrier discharge plasma:influence of peak voltage

This paper discusses the use of atmospheric pressure dielectric barrier discharge(DBD)plasma treatment to enhance the surface qualities of viscose fabrics.The study explores the effects of different plasma gases,discharge voltages,and exposure times on the treated fabrics.The findings emphasize the importance of optimizing the plasma's peak voltage to achieve the desired surface treatment outcomes.The document also presents data on colour strength,wettability,colour fastness,and tensile strength of the treated fabrics,as well as scanning electron microscopy(SEM)analysis of surface morphology and chemical analysis using fouriertransition infrared spectroscopy(FTIR)and energy dispersive X-ray(EDX).The results show that treatment at a peak voltage of 11.83 k V is more efficient,except for the tensile strength which is enhanced at a peak voltage of 8.92 k V.The oxygen plasma treatment significantly improves the colour strength,which exhibits an increase from 11 to 18.The intensified colour was attributed to the significant influence of electrostatic interactions between the charged hydroxyl groups of the oxygen plasma treated viscose textiles and the dye molecules,which enhance the printability.The oxygen DBD plasma exhibits a higher ability to enhance the properties of textiles when compared to air and argon plasmas.This study presents a sustainable,economical,secure,and ecologically friendly approach to explore new fabrics for specific uses.

Cellular preconditioning and mesenchymal stem cell ferroptosis

In this editorial,we comment on the article published in the recent issue of the World Journal of Stem Cells.They focus on stem cell preconditioning to prevent ferroptosis by modulating the cystathionineγ-lyase/hydrogen sulfide(H_(2)S)pathway as a novel approach to treat vascular disorders,particularly pulmonary hypertension.Preconditioned stem cells are gaining popularity in regenerative medicine due to their unique ability to survive by resisting the harsh,unfavorable microenvironment of the injured tissue.They also secrete various paracrine factors against apoptosis,necrosis,and ferroptosis to enhance cell survival.Ferroptosis,a regulated form of cell death characterized by iron accumulation and oxidative stress,has been implicated in various pathologies encompassing dege-nerative disorders to cancer.The lipid peroxidation cascade initiates and sustains ferroptosis,generating many reactive oxygen species that attack and damage multiple cellular structures.Understanding these intertwined mechanisms provi-des significant insights into developing therapeutic modalities for ferroptosis-related diseases.This editorial primarily discusses stem cell preconditioning in modulating ferroptosis,focusing on the cystathionase gamma/H_(2)S ferroptosis pathway.Ferroptosis presents a significant challenge in mesenchymal stem cell(MSC)-based therapies;hence,the emerging role of H_(2)S/cystathionase gamma/H_(2) S signaling in abrogating ferroptosis provides a novel option for therapeutic intervention.Further research into understanding the precise mechanisms of H_(2)S-mediated cytoprotection against ferroptosis is warranted to enhance the thera-peutic potential of MSCs in clinical settings,particularly vascular disorders.

Mesenchymal stem cells’“garbage bags”at work:Treating radial nerve injury with mesenchymal stem cell-derived exosomes

Unlike central nervous system injuries,peripheral nerve injuries(PNIs)are often characterized by more or less successful axonal regeneration.However,structural and functional recovery is a senile process involving multifaceted cellular and molecular processes.The contemporary treatment options are limited,with surgical intervention as the gold-standard method;however,each treatment option has its associated limitations,especially when the injury is severe with a large gap.Recent advancements in cell-based therapy and cell-free therapy approaches using stem cell-derived soluble and insoluble components of the cell secretome are fast-emerging therapeutic approaches to treating acute and chronic PNI.The recent pilot study is a leap forward in the field,which is expected to pave the way for more enormous,systematic,and well-designed clinical trials to assess the therapeutic efficacy of mesenchymal stem cell-derived exosomes as a bio-drug either alone or as part of a combinatorial approach,in an attempt synergize the best of novel treatment approaches to address the complexity of the neural repair and regeneration.

Geochemistry of island arc assemblage in the Eastern Desert of Egypt and the role of Pan-African magmatism in crustal growth of the Arabian–Nubian Shield:A review

Neoproterozoic island arc assemblage of the Arabian–Nubian Shield(ANS)in the Eastern Desert(ED)of Egypt comprises juvenile suites of metavolcanics(MV),large amounts of meta-sedimentary rocks(MS),and voluminous metagabbros-diorites(MGD)and syn-tectonic intrusions of older granitoids(OG).We report here the updates of these four rock units in terms of classification,distribution,chemical characteristics,geodynamic evolution,metamorphism,and ages.In addition,we discuss these integrated data to elucidate a reasonable and reliable model for crustal evolution in the ANS.The main features of these rock units indicate their relation to each other and the geodynamic environment dominated by early immature oceanic island arcs to primitive continental arcs.Integrated information of the island arc metavolcanic and plutonic rocks(gabbros,diorites,tonalites,and granodiorites)furnish evidence of the genetic relationships.These include proximity and a coeval nature in the field;all protolith magmas are subalkaline in nature following calc-alkaline series with minor tholeiitic affinities;common geochemical signature of the arc rocks and subduction-related magmatism;their similar enrichment in LREEs;and similar major element compositions with mafic melts derived from metasomatized mantle wedge.The volcano-sedimentary and the OG rocks underwent multiphase deformation events whereas the MGD complexes deformed slightly.Based on the magmatic,sedimentological,and metamorphic evolutions constrained by geochronological data as well as the progressive evolutionary trend from extensional to compressional regimes,a possible gradual decrease in the subducted slab dip angle is the most infl uential in any geodynamic model for arc assemblage in the ED of Egypt.

Computed tomography for prediction of esophageal variceal bleeding

This letter to the editor relates to the study entitled“The role of computed tomography for the prediction of esophageal variceal bleeding:Current status and future perspectives”.Esophageal variceal bleeding(EVB)is one of the most common and severe complications related to portal hypertension(PH).Despite marked advances in its management during the last three decades,EVB is still associated with significant morbidity and mortality.The risk of first EVB is related to the severity of both PH and liver disease,and to the size and endoscopic appearance of esophageal varices.Indeed,hepatic venous pressure gradient(HVPG)and esophagogastroduodenoscopy(EGD)are currently recognized as the“gold standard”and the diagnostic reference standard for the prediction of EVB,respectively.However,HVPG is an invasive,expensive,and technically complex procedure,not widely available in clinical practice,whereas EGD is mainly limited by its invasive nature.In this scenario,computed tomography(CT)has been recently proposed as a promising modality for the non-invasive prediction of EVB.While CT serves solely as a diagnostic tool and cannot replace EGD or HVPG for delivering therapeutic and physiological information,it has the potential to enhance the prediction of EVB more effectively when combined with liver disease scores,HVPG,and EGD.However,to date,evidence concerning the role of CT in this setting is still lacking,therefore we aim to summarize and discuss the current evidence concerning the role of CT in predicting the risk of EVB.

New Antenna Array Beamforming Techniques Based on Hybrid Convolution/Genetic Algorithm for 5G and Beyond Communications

Side lobe level reduction(SLL)of antenna arrays significantly enhances the signal-to-interference ratio and improves the quality of service(QOS)in recent and future wireless communication systems starting from 5G up to 7G.Furthermore,it improves the array gain and directivity,increasing the detection range and angular resolution of radar systems.This study proposes two highly efficient SLL reduction techniques.These techniques are based on the hybridization between either the single convolution or the double convolution algorithms and the genetic algorithm(GA)to develop the Conv/GA andDConv/GA,respectively.The convolution process determines the element’s excitations while the GA optimizes the element spacing.For M elements linear antenna array(LAA),the convolution of the excitation coefficients vector by itself provides a new vector of excitations of length N=(2M−1).This new vector is divided into three different sets of excitations including the odd excitations,even excitations,and middle excitations of lengths M,M−1,andM,respectively.When the same element spacing as the original LAA is used,it is noticed that the odd and even excitations provide a much lower SLL than that of the LAA but with amuch wider half-power beamwidth(HPBW).While the middle excitations give the same HPBWas the original LAA with a relatively higher SLL.Tomitigate the increased HPBWof the odd and even excitations,the element spacing is optimized using the GA.Thereby,the synthesized arrays have the same HPBW as the original LAA with a two-fold reduction in the SLL.Furthermore,for extreme SLL reduction,the DConv/GA is introduced.In this technique,the same procedure of the aforementioned Conv/GA technique is performed on the resultant even and odd excitation vectors.It provides a relatively wider HPBWthan the original LAA with about quad-fold reduction in the SLL.

Salivary C-reactive protein and mean platelet volume as possible diagnostic markers for late-onset neonatal pneumonia

BACKGROUND Neonatal sepsis,a formidable threat to newborns,is a leading cause of neonatal mortality,with late-onset sepsis manifesting after 72 hours post-birth being particularly concerning.Pneumonia,a prevalent sepsis presentation,poses a significant risk,especially during the neonatal phase when lung defenses are compromised.Accurate diagnosis of pneumonia is imperative for timely and effective interventions.Saliva,a minimally invasive diagnostic medium,holds great promise for evaluating infections,especially in infants.AIM To investigate the potential of serum C-reactive protein(CRP),salivary CRP(sCRP),and mean platelet volume(MPV)as diagnostic markers for late-onset neonatal pneumonia(LONP).METHODS Eighty full-term neonates were systematically examined,considering anthropometric measurements,clinical manifestations,radiology findings,and essential biomarkers,including serum CRP,sCRP,and MPV.RESULTS The study reveals noteworthy distinctions in serum CRP levels,MPV,and the serum CRP/MPV ratio between neonates with LONP and healthy controls.MPV exhibited a robust discriminatory ability[area under the curve(AUC)=0.87]with high sensitivity and specificity at a cutoff value of>8.8.Correlations between serum CRP,sCRP,and MPV were also identified.Notably,sCRP demonstrated excellent predictive value for serum CRP levels(AUC=0.89),underscoring its potential as a diagnostic tool.CONCLUSION This study underscores the diagnostic promise of salivary and serum biomarkers,specifically MPV and CRP,in identifying and predicting LONP among neonates.These findings advocate for further research to validate their clinical utility in larger neonatal cohorts.

Gastrointestinal tolerability of organic infant formula compared to traditional infant formula: A systematic review

BACKGROUND Infants'nutrition significantly influences their growth,development,and overall well-being.With the increasing demand for organic infant formula driven by the perception of health benefits and growing awareness of natural feeding options,it is crucial to conduct a comparative analysis of the gastrointestinal tolerability between organic and traditional infant formulas.AIM To provide a concise and precise analysis of the gastrointestinal tolerability of organic infant formula compared to traditional infant formula.Due to limited direct comparisons,the review synthesizes available literature on each formula type,presenting insights into their potential effects on infants'digestive health.METHODS An extensive literature search was conducted,compiling studies on organic and traditional infant formulas,their compositions,and reported effects on gastrointestinal tolerability.We searched academic databases such as PubMed and Google Scholar and specialized nutrition,paediatrics,and infant health journals using relevant keywords till October 1,2023.RESULTS Although specific comparative studies are scarce and formula heterogeneity is a significant limitation,this systematic review provides an in-depth understanding of organic infant formulas'composition and potential benefits.While scientific evidence directly comparing gastrointestinal tolerability is limited,organic formulas strive to use carefully selected organic ingredients to imitate breast milk composition.Potential benefits include improved lipid profiles,higher methionine content,and decreased antibiotic-resistant bacteria levels.Understanding the gastrointestinal tolerability of organic and traditional infant formulas is crucial for parents and healthcare providers to make informed decisions.CONCLUSION Despite limitations in direct comparisons,this systematic review provides insights into the composition and potential benefits of organic infant formulas.It emphasizes the need for further research to elucidate their gastrointestinal effects comprehensively.

Microphallus early management in infancy saves adulthood sensual life:A comprehensive review

Microphallus/Micropenis is a rare condition with significant physical and psychological implications for affected individuals.This article comprehensively reviews micropenis,its etiology,epidemiology,and various treatment options.We conducted a thorough literature review to collect relevant information on micropenis and microphallus,as well as related disorders.Our primary databases were PubMed,Medline,and Google Scholar.We searched for articles published in English between 2000 and 2023.Our analysis included 67 review articles,56 research studies,11 case reports,one guideline,and one editorial.Our search terms included"microphallus","micropenis","congenital hypogonadotropic hypogonadism","androgen insensitivity syndrome","pediatric management of micropenis","testosterone therapy",and"psychosocial implications of micropenis".We focused on diagnosing micropenis and related conditions,including hormonal assessments,medical and surgical treatment options,psychosocial and psychological well-being,sexual development of adolescents,and sociocultural influences on men's perceptions of penile size.Additionally,we explored parenting and family dynamics in cases of micropenis and disorders of sex development,implications of hormonal treatment in neonates,and studies related to penile augmentation procedures and their effectiveness.The article highlights the importance of early diagnosis and intervention in addressing the physical and psychological well-being of individuals with micropenis.Surgical procedures,such as penile lengthening and girth enhancement,and non-surgical approaches like hormonal therapy are explored.The significance of psychological support,education,and lifestyle modifications is emphasized.Early management and comprehensive care are crucial for individuals with micropenis,from infancy to adolescence and beyond.A multidisciplinary approach involving urologists,endocrinologists,and mental health professionals is recommended.Regular assessment of treatment effectiveness and the need for updated guidelines are essential to provide the best possible care.Healthcare professionals should prioritize early diagnosis,and neonatologists should measure stretched penile length in neonates.A collaborative effort is needed among professionals,parents,and affected individuals to create a supportive environment that recognizes worth beyond physical differences.Continuous research and evidencebased updates are crucial for improving care standards.

Fecal calprotectin in pediatric gastrointestinal diseases:Pros and cons

BACKGROUND Fecal calprotectin is a valuable biomarker for assessing intestinal inflammation in pediatric gastrointestinal diseases.However,its role,pros,and cons in various conditions must be comprehensively elucidated.AIM To explore the role of fecal calprotectin in pediatric gastrointestinal diseases,including its advantages and limitations.METHODS A comprehensive search was conducted on PubMed,PubMed Central,Google Scholar,and other scientific research engines until February 24,2024.The review included 88 research articles,56 review articles,six metaanalyses,two systematic reviews,two consensus papers,and two letters to the editors.RESULTS Fecal calprotectin is a non-invasive marker for detecting intestinal inflammation and monitoring disease activity in pediatric conditions such as functional gastrointestinal disorders,inflammatory bowel disease,coeliac disease,coronavirus disease 2019-induced gastrointestinal disorders,gastroenteritis,and cystic fibrosis-associated intestinal pathology.However,its lack of specificity and susceptibility to various confounding factors pose challenges in interpretation.Despite these limitations,fecal calprotectin offers significant advantages in diagnosing,monitoring,and managing pediatric gastrointestinal diseases.CONCLUSION Fecal calprotectin holds promise as a valuable tool in pediatric gastroenterology,offering insights into disease activity,treatment response,and prognosis.Standardized protocols and guidelines are needed to optimize its clinical utility and mitigate interpretation challenges.Further research is warranted to address the identified limitations and enhance our understanding of fecal calprotectin in pediatric gastrointestinal diseases.

Metabolomic changes in children with autism

BACKGROUND Autism spectrum disorder(ASD)is a neurodevelopmental condition characterized by deficits in social communication and repetitive behaviors.Metabolomic profiling has emerged as a valuable tool for understanding the underlying metabolic dysregulations associated with ASD.AIM To comprehensively explore metabolomic changes in children with ASD,integrating findings from various research articles,reviews,systematic reviews,meta-analyses,case reports,editorials,and a book chapter.METHODS A systematic search was conducted in electronic databases,including PubMed,PubMed Central,Cochrane Library,Embase,Web of Science,CINAHL,Scopus,LISA,and NLM catalog up until January 2024.Inclusion criteria encompassed research articles(83),review articles(145),meta-analyses(6),systematic reviews(6),case reports(2),editorials(2),and a book chapter(1)related to metabolomic changes in children with ASD.Exclusion criteria were applied to ensure the relevance and quality of included studies.RESULTS The systematic review identified specific metabolites and metabolic pathways showing consistent differences in children with ASD compared to typically developing individuals.These metabolic biomarkers may serve as objective measures to support clinical assessments,improve diagnostic accuracy,and inform personalized treatment approaches.Metabolomic profiling also offers insights into the metabolic alterations associated with comorbid conditions commonly observed in individuals with ASD.CONCLUSION Integration of metabolomic changes in children with ASD holds promise for enhancing diagnostic accuracy,guiding personalized treatment approaches,monitoring treatment response,and improving outcomes.Further research is needed to validate findings,establish standardized protocols,and overcome technical challenges in metabolomic analysis.By advancing our understanding of metabolic dysregulations in ASD,clinicians can improve the lives of affected individuals and their families.

The Glenn Shunt Revisited, A Single Center Registry in Ain Shams University Cardiology Department

Background:Bidirectional Glenn shunts have long been available as palliative procedures for patients with single ventricle physiology that is,patients unsuitable for biventricular repair.In our country they are performed at an older age than that recommended by the literature.So,we aim to assess post bidirectional Glenn shunt patients to detect the presence of any complications and to evaluate their functional capacity.Methods:This was a descriptive study that included all patients who underwent a bidirectional Glenn shunt and were referred for follow up in Ain shams university hospitals.History taking including NYHA class and physical activity,clinical examination,six-minutes-walk test,laboratory investigations,full echocardiographic assessment were done for all patients.Some patients needed invasive cardiac catheterization.Results:Our registry included 178 patients who underwent bidirectional Glenn procedure referred for follow up in Ain Shams university hospital from January 2019 till July 2020.The mean age of the registry was 18.7±8.26 years(range between 5 and 37 years),85 males(48%)and 93 females(52%).Regarding the basic anatomy,double outlet right ventricle with hypoplastic left ventricle was the commonest.Furthermore,our descriptive study confirmed many characteristic similarities between our patients and patients in developing countries.Our patients underwent bidirectional Glenn shunt at a median age of 6 years which is considered a relatively old age but similar to other studies that have been made in developing countries like Pakistan,India and Iran.There is a significant delay in the operation in Egyptian patients due to lack of patients’awareness,few numbers of primary health care facilities and high economic burden.Conclusion:Although the presence of slight systemic desaturation,our study demonstrated a satisfactory functional capacity among our patients;thus,bidirectional Glenn can be considered an acceptable definite univentricular repair in patients with late presentation.

Performance of Green Aggregate Produced by Recycling Demolition Construction Wastes (Case Study of Tanta City)

Egypt has a high attitude in construction and demolition waste (CDW) amounts causing a negative impact on the environment. The use of such waste for infrastructures applications can be useful for each environment and in addition an economic benefit to it in the construction. This study explores the possibility of replacing natural coarse aggregate with recycled concrete construction and demolition waste aggregate for general purpose concrete (i.e. plain concrete and low strength structural concrete). Different samples of CDW were extracted from different demolition sites and landfill locations around Tanta city area for the experimental investigation. CDW was crushed with all its hard constituents (e.g. concrete, brick etc.) found in the landfill. Coarse size crushed CDW was used as a coarse aggregate for concrete. Main characteristics of CDW aggregate determined in addition to the main properties of concrete which was made using this aggregate were measured. The results showed that the CDW could be transformed into recycled concrete aggregate leading to reduction in the concrete compressive strength ranged from 37% to 62% depending on the type of the CDW constituents.

Pleural effusion in critically ill patients and intensive care setting

Pleural effusion usually causes a diagnostic dilemma with a long list of differential diagnoses.Many studies found a high prevalence of pleural effusions in critically ill and mechanically ventilated patients,with a wide range of variable prevalence rates of up to 50%-60%in some studies.This review emphasizes the importance of pleural effusion diagnosis and management in patients admitted to the intensive care unit(ICU).The original disease that caused pleural effusion can be the exact cause of ICU admission.There is an impairment in the pleural fluid turnover and cycling in critically ill and mechanically ventilated patients.There are also many difficulties in diagnosing pleural effusion in the ICU,including clinical,radiological,and even laboratory difficulties.These difficulties are due to unusual presentation,inability to undergo some diagnostic procedures,and heterogenous results of some of the performed tests.Pleural effusion can affect the patient’s outcome and prognosis due to the hemodynamics and lung mechanics changes in these patients,who usually have frequent comorbidities.Similarly,pleural effusion drainage can modify the ICUadmitted patient’s outcome.Finally,pleural effusion analysis can change the original diagnosis in some cases and redirect the management toward a different way.

Cardiometabolic effects of breastfeeding on infants of diabetic mothers

BACKGROUND Breast milk is the best and principal nutritional source for neonates and infants.It may protect infants against many metabolic diseases,predominantly obesity and type 2 diabetes.Diabetes mellitus(DM)is a chronic metabolic and microvascular disease that affects all the body systems and all ages from intrauterine life to late adulthood.Breastfeeding protects against infant mortality and diseases,such as necrotizing enterocolitis,diarrhoea,respiratory infections,viral and bacterial infection,eczema,allergic rhinitis,asthma,food allergies,malocclusion,dental caries,Crohn's disease,and ulcerative colitis.It also protects against obesity and insulin resistance and increases intelligence and mental development.Gestational diabetes has short and long-term impacts on infants of diabetic mothers(IDM).Breast milk composition changes in mothers with gestational diabetes.AIM To investigate the beneficial or detrimental effects of breastfeeding on the cardiometabolic health of IDM and their mothers.METHODS We performed a database search on different engines and a thorough literature review and included 121 research published in English between January 2000 and December 15,2022,in this review.RESULTS Most of the literature agreed on the beneficial effects of breast milk for both the mother and the infant in the short and long terms.Breastfeeding protects mothers with gestational diabetes against obesity and type 2 DM.Despite some evidence of the protective effects of breastfeeding on IDM in the short and long term,the evidence is not strong enough due to the presence of many confounding factors and a lack of sufficient studies.CONCLUSION We need more comprehensive research to prove these effects.Despite many obstacles that may enface mothers with gestational diabetes to start and maintain breastfeeding,every effort should be made to encourage them to breastfeed.

Role of Vascular Endothelial Growth Factor-C during Stem Cell Therapy Using Autologous Bone Marrow Mononuclear Cells in Patients with Lower Limb Lymphedema

Introduction: Vascular endothelial growth factor-C (VEGF-C) is the primary lymphangiogenic factor that stimulates lymphangiogenesis by signaling via specific receptor, vascular endothelial growth factor receptor 3 (VEGFR3). This study was conducted to evaluate the change in the level of VEGF-C before and after autologous bone marrow mononuclear cell transplantation for treatment of Lower limb lymphedema. Patient and methods: Forty patients with lower limb lymphedema were divided into two groups. Group I included 20 patients with chronic lower limb lymphedema who underwent autologous bone marrow mononuclear cell transplantation. Group II included 20 patients with chronic lower limb lymphedema who were exposed only to compression therapy as a control group. VEGF-C level in the diseased limbs was measured in both groups at the beginning of the study then 3 and 6 months respectively. Results: Group I included 20 patients, 8 patients were male (40%) and 12 patients were females (60%) with mean age 29.5 ± 12.15 while group II included 20, 10 patients were male (50%) and 10 patients were females (50%) with mean age 39.5 ± 11.5. In group I, the specimens were taken at 3 and 6 months after transplantation showed a marked decrease in the VEGF-C level with statistically significant p value, 0.02 and 0.001 respectively. In group II the level of VEGF-C after compression therapy alone at 3 and 6 months interval showed fluctuation with statistically non-significant p value, 0.64 and 0.55 respectively. Conclusion: VEGF-C is essential for regulation of lymphangiogenesis. The level of VEGF-C was found elevated in patients with lymphedema and decrease after autologous mononuclear bone marrow cells, however these results were statically non-significant.