Abstract : Although COVID-19 is milder in young than adults. However, it can cause pneumonia in children eventually requiring hospitalization. Clinical similarity between COVID-19, other viral, and bacterial pneumonia at initial presentation of the disease caused a great challenge. We aimed to differentiate COVID-19 pneumonia from other viral and bacterial pneumonia in children, and to characterize it . Materials and Methods: This study included 300 children, who were hospitalized with clinically and radiologically confirmed pneumonia during COVID-19 pandemic. Clinical symptoms were collected and analyzed . Cultures , real time polymerase chain transcriptase test for some respiratory viruses and SARS-COV2, C-reactive protein, serum procalcitonin ,serum ferritin , complete blood counts , and ferritin/procalcitonin ratio were done for all patients Results: This study showed that COVID-19 pneumonia was only 15 % of all admitted pneumonia cases. It had low proportion of high fever , mild course, significant lymphopenia , significant thrombocytopenia, low procalcitonin , low C-reactive protein , higher ferritin / procalcitonin ratio , and higher neutrophil/ lymphocyte ratio , significant high percentage of ground glass , and less percentage of consolidation in CT images . Conclusion: During ( COVID-19) outbreak, pneumonia due to COVID-19 was less common , and less severe than that caused by other viruses or bacteria in children. Naso- pharyngeal swabs for multi-respiratory pathogen, including SARS-COV-2, are required to not to attribute most pneumonia cases to be due to COVID-19. However , further large-sample studies are needed to have full blown picture about COVID-19 pneumonia in children.

BACKGROUND:Complete revascularization is the standard treatment for patients with ST-segment-elevation myocardial infarction and multivessel disease. The FIRE trial (Functional Assessment in Elderly Myocardial Infarction Patients With Multivessel Disease) confirmed the benefit of complete revascularization in a population of older patients, but the follow-up is limited to 1 year. Therefore, the long-term benefit (>1 year) of this strategy in older patients is debated. To address this, an individual patient data meta-analysis was conducted in patients with ST-segment-elevation myocardial infarction ≥75 years of age enrolled in randomized clinical trials investigating complete versus culprit-only revascularization strategies. METHODS:PubMed, Embase, and the Cochrane database were systematically searched to identify randomized clinical trials comparing complete versus culprit-only revascularization. Individual patient-level data were collected from the relevant trials. The primary end point was death, myocardial infarction, or ischemia-driven revascularization. The secondary end point was cardiovascular death or myocardial infarction. RESULTS:Data from 7 randomized clinical trials encompassing 1733 patients (917 randomized to culprit-only and 816 to complete revascularization) were analyzed. The median age was 79 [interquartile range, 77-83] years. Of the patients, 595 (34%) were female. Follow-up ranged from a minimum of 6 months to a maximum of 6.2 years (median, 2.5 [interquartile range, 1-3.8] years). Complete revascularization reduced the primary end point up to 4 years (hazard ratio, 0.78 [95% CI, 0.63-0.96]) but not at the longest available follow-up (hazard ratio, 0.83 [95% CI, 0.69-1.01]). Complete revascularization significantly reduced the occurrence of cardiovascular death or myocardial infarction at the longest available follow-up (hazard ratio, 0.76 [95% CI, 0.58-0.99]). This was observed even when censoring the follow-up at each year. Long-term rate of death did not differ between complete and culprit-only revascularization arms. CONCLUSIONS:In this individual patient data meta-analysis of older patients with ST-segment-elevation myocardial infarction and multivessel disease, complete revascularization reduced the primary end point of death, myocardial infarction, or ischemia-driven revascularization up to 4 years. At the longest follow-up, complete revascularization reduced the composite of cardiovascular death or myocardial infarction but not the primary end point. REGISTRATION:URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42022367898.

The prevalence of cardiac complications linked to celiac disease (CD) is on expanding. This study aimed to evaluate the cardiac function in children with CD using two dimensional speckle tracking echocardiography (2D-STE) to detect early myocardial dysfunction, if any. This cross-sectional study included 40 children with CD as the patient group and 40 healthy age- and sex-matched children served as the control group. High sensitive troponin T (Hs-troponin T), anti-tissue transglutaminase immunoglobulin A (tTG-IgA), hemoglobin, ferritin, albumin, and vitamin D levels were measured in all participants. Conventional, tissue Doppler imaging (TDI), and 2D-STE were performed for all included children. Conventional echocardiographic parameters showed no significant difference between the two groups. Left ventricular global longitudinal strain (LV GLS) obtained by 2D-STE was substantially lower in children with CD than the control group; however, myocardial performance index (MPI) obtained by TDI was significantly higher in children with CD. Hs-troponin T levels were comparable in both groups. LV GLS was positively correlated with hemoglobin, ferritin, and albumin level, but it was inversely correlated with the duration of the disease and anti tTG-IgA. Conclusion : 2D-STE can detect subclinical early cardiac dysfunction in children with CD and this cardiac injury correlated to the duration and severity of the disease and some nutritional deficiency in these children. What is Known: • The prevalence of cardiac complications linked to celiac disease (CD) is on expanding . • Only one study evaluated cardiac function in children with CD using two dimensional speckle tracking echocardiography (2D-STE) . What is New: • Our study found that 2D-STE can detect early subclinical cardiac dysfunction in children with CD. Cardiac injury in theses children correlated to the duration and severity of the disease, hemglobin, ferritin, and albumin levels .

There is increasing evidence linking chronic inflammation to the initiation and continuation of atrial fibrillation (AF). Inflammatory bowel diseases (IBD), namely (Crohn’s disease (CD) and ulcerative colitis (UC), are chronic systemic inflammatory disorders with both intestinal and extra-intestinal manifestations. Atrial electromechanical delay (EMD) has been known as an early marker of AF. The objective of this study was to evaluate the atrial electromechanical properties in children and adolescents with IBD during remission. One hundred IBD patients aged 12–17 years (50 with CD and 50 with UC) in remission state and 100 healthy controls were recruited for the study. Atrial electromechanical properties were measured using transthoracic echocardiography, tissue Doppler imaging, and simultaneous surface ECG recording. Interatrial EMD, left intra-atrial, and right intra-atrial EMD were calculated. IBD patients in remission state have significantly prolonged left and right intra-atrial EMD and interatrial EMD compared to healthy controls ( P = 0.03, P = 0.02, and P = 0.01 respectively). No statistical difference was observed between CD and UC in terms of inter- and intra-atrial EMDs. Conclusion : Atrial EMD is increased in pediatric patients with IBD indicating the increased risk of AF development. Measurement of atrial EMD parameters might be used to predict the risk of the development of AF in pediatric patients with IBD. What is Known: • There is increasing evidence linking chronic inflammation to the initiation and continuation of atrial fibrillation (AF). • Inflammatory bowel diseases are chronic systemic inflammatory disorders with both intestinal and extra-intestinal manifestations. • Atrial electromechanical delay (EMD) has been reported as an early marker of AF. What is New: • Atrial EMD is increased in pediatric patients with IBD indicating the increased risk of AF development. • Measurement of atrial EMD parameters might be used to predict the risk of the development of AF in pediatric patients with IBD.

Background: Polycystic ovary syndrome (PCOS) is a syndrome of chronic anovulation, obesity, and androgen excess, and can affect sexual function in reproductive age women. Aim of the Work:To determine the prevalence of sexual dysfunction in women with primary infertility due to PCOS undergoing fertility treatment and predisposing factors.Patients and Methods: Observational cross-sectional study that included an Egyptian convenient sample of 186 females with primary infertility due to polycystic ovary syndrome , aging between 18-35 , recruited from Kasr Al-Ainy infertility Clinic.Results: Using a cutoff score of 26.55 on the FSFI-Q, the prevalence of female sexual dysfunction (FSD) was 30.1 % among the study subjects.The most affected domains were orgasm ( 45.7%) and satisfaction (53.8%) while the least affected in both groups was the desire domain ( 30.1 %).Those using Clomiphene citrate , gonadotrophin & IVF had more prevalence of sexual dysfunction ( P value < 0.005).Females with bad feeling towards their husband & hairsute females had higher prevalence of female sexual dysfunction ( P value < 0.005). Conclusion:The present study demonstrated an association between the PCOS infertility and the prevalence female sexual dysfunction.The scope of the problem is basically due to low self-esteem , the bad perception body image of an obese hairsute female , the stress of delayed conception in addition to the superimposed bad relation with their husbands.

Phenylalanine hydroxylase (PAH) enzyme plays a key role in dopamine biosynthesis in humans, rabbits, and most mammals.Rabbits, as an ideal model, were used to study the expression of the PAH gene under different feeding conditions of faba bean (Vicia faba L., Sakha 3).PAH genes (≈1,400 bp) in control and faba beanfed rabbits were PCR amplified, sequenced, and aligned with the reference gene (acc.no.013672).The first 320 pb of PAH sequences representing the N-terminal of the gene was almost identical.High genetic similarity values were detected in PAH gene sequences for both control and faba bean-fed rabbits with the reference gene (99.80%).The results indicated very little sequence variations, which have no effect on the enzyme activity in both control and faba bean-fed rabbits.Real Time quantitative Polymerase Chain Reaction (RT-qPCR) analysis showed that the PAH gene was overexpressed after feeding on dry faba bean form compared with feeding on the fresh form.Furthermore, Western blotting results reflected superior PAH protein due to the direct influence of feeding on dry faba bean.In conclusion, our findings indicated the direct effect of fresh and dry faba bean diet on increasing phenylalanine amino acid in rabbits' blood, which consequently increases the expression of PAH gene, thus improving the quality of life for humans.

Background and Objective: The expression of genetic variability of the yield components in sesame is strongly influenced by inter-plant competition.Thus, information on the degree of dependence of seed yield per unit area on each of these components under different levels of intra-row spacing was evaluated and establishing optimum population densities.Materials and Methods: Two field experiments were conducted in the Experimental Station of the Faculty of Agriculture, Cairo University, Giza Governorate, Egypt during the summer seasons of 2015 and 2016.The experimental design was the split-plot arrangement in a randomized complete blocks design repeated four times.The main plots were devoted to intra-row spacing (10, 20 and 30 cm) providing three plant densities of 105 000, 70 000 and 35 000 plant fedG 1 , respectively and sub-plots to three genotypes (D1, 2 and Shandauil-3).Results: The highest seed yield (kg) was realized from Line-2 with 105000 plant fedG 1 .Shandauil-3cv. out yielded significantly the other two genotypes in number of fruiting nodes/plant, capsule length, number of seeds/capsule and fruit zone length.Fatty acids profile reflected little variations not only among sesame genotypes but also intra-row spacing.Conclusion: The study acknowledges the higher seed and oil yield of sesame could be obtained by using genotype Line-D1 sowing at 10 cm between hills under the agro-climatic conditions of Giza, Egypt.

Estudiar el impacto de la inyección intracoronaria de eptifibatida más vasodilatadores a través de un catéter de aspiración de trombos frente a la aspiración de trombos aislada en la reducción del riesgo de ausencia de reperfusión (no-reflow) en infarto agudo de miocardio con elevación del ST (IAMCEST) con diabetes y elevada carga de trombos. Participaron 413 pacientes diabéticos con IAMCEST y elevada carga de trombos que se aleatorizaron a inyección intracoronaria (distal a la oclusión) de eptifibatida, nitroglicerina y verapamilo después de aspirar el trombo y previo al inflado del balón (n = 206) frente a aspiración del trombo únicamente (n = 207). El criterio de valoración principal fue el grado de blush miocárdico (GBM) y el Thrombolysis in Myocardial Infarction (TIMI) frame count corregido (cTFC). Los eventos cardiovasculares adversos mayores (MACE) se notificaron a los 6 meses. El grupo de eptifibatida intracoronaria y vasodilatadores fue superior a la tromboaspiración sola en lo que respecta a la MBG-3 (82,1% frente a 31,4%; p = 0,001). El grupo de eptifibatida y vasodilatadores intracoronarios locales tuvo un cTFC más corto (18,16 ± 6,54 frente a 29,64 ± 5,53; p = 0,001), y mejor flujo TIMI-3 (91,3% frente a 61,65%; p = 0,001). La eptifibatida intracoronaria y los vasodilatadores mejoraron la fracción de eyección a los 6 meses (55,2 ± 8,13 frente a 43 ± 6,67; p = 0,005). No hubo diferencia en las tasas de MACE a los 6 meses. Entre los pacientes diabéticos con IAMCEST y alta carga de trombos, la inyección intracoronaria distal de eptifibatida más vasodilatadores fue beneficiosa en prevenir la falta de reperfusión comparada con la tromboaspiración sola. Se recomiendan estudios más amplios para investigar el beneficio de esta estrategia en reducir el riesgo de eventos clínicos adversos. To study the impact of injecting intracoronary eptifibatide plus vasodilators via thrombus aspiration catheter vs thrombus aspiration alone in reducing the risk of no-reflow in acute ST-elevation myocardial infarction (STEMI) with diabetes and high thrombus burden. The study involved 413 diabetic STEMI patients with high thrombus burden, randomized to intracoronary injection (distal to the occlusion) of eptifibatide, nitroglycerin and verapamil after thrombus aspiration and prior to balloon inflation (n = 206) vs thrombus aspiration alone (n = 207). The primary endpoint was post procedural myocardial blush grade and corrected Thrombolysis in Myocardial Infarction (TIMI) frame count (cTFC). Major adverse cardiovascular events were reported at 6 months. The intracoronary eptifibatide and vasodilators arm was superior to thrombus aspiration alone regarding myocardial blush grade-3 (82.1% vs 31.4%; P = .001). The local intracoronary eptifibatide and vasodilators arm had shorter cTFC (18.16 ± 6.54 vs 29.64 ± 5.53, P = .001), and better TIMI 3 flow (91.3% vs 61.65%; P = .001). Intracoronary eptifibatide and vasodilators improved ejection fraction at 6 months (55.2 ± 8.13 vs 43 ± 6.67; P = .005). There was no difference in the rates of major adverse cardiovascular events at 6 months. Among diabetic patients with STEMI and high thrombus burden, intracoronary eptifibatide plus vasodilators injection was beneficial in preventing no-reflow compared with thrombus aspiration alone. Larger studies are encouraged to investigate the benefit of this strategy in reducing the risk of adverse clinical events.

Background Thoracoscopic surgeries are an absolute indication of one lung ventilation OLV, the choice of using volume-controlled ventilation (VCV) or pressure controlled ventilation (PCV) remains controversial. Respiratory complications are major cause of postoperative morbidity which is associated with increased extravascular lung water (EVLW). Assessment of (EVLW) helps in early detection and treatment of respiratory complications. Lung ultrasound (LUS) has been suggested as reliable method of assessment of EVLW. This study was designed to figure out whether there was any difference in OLV by either PCV or VCV on EVLW water in the ventilated lung using LUS score and arterial oxygenation.Methodology 50 patients were randomly assigned into two groups; Group V: received VCV (Vt 7 ml/kg ideal body weight) Group P: received PCV (To achieve Vt 7 ml/kg ideal body weight, Pmax 30 cmh2o)Results We found that both techniques PCV and VCV showed no statistically significant differences as regards the ultrasound score at different timings of measurement; (T0) before induction of anesthesia, (T5) immediately at the end of operation after extubation, and (T6) 2 hours after ICU admission. Where P values were 0.525, 0.309, and 0.597 consecutively, we also found there were no statistically significant differences between the two groups regarding hemodynamics, arterial blood gases, ventilatory parameters.Conclusion We concluded that when utilizing VCV & PCV in OLV in thoracospic surgeries there was no statistically significant difference regarding EVLW score measured by LUS in the ventilated lung.

OBJECTIVES:Weaning individuals from mechanical ventilation (MV) is a challenge to physicians. Respiratory failure is the main reason for weaning failure (WF), but heart failure plays a pivotal role as well. Transesophageal Doppler (TED) is a minimally invasive method of hemodynamic tracking with fewer problems. The study authors evaluated the role of TED in predicting WF.DESIGN:An observational study.SETTING:A university teaching hospital.PARTICIPANTS:Weaning individuals.INTERVENTIONS:TED was applied before initiating the spontaneous breathing trial (SBT). Hemodynamic parameters, arterial blood gases, and TED (peak velocity [PV], cardiac output [COP]) were reported while cases were on MV before initiating the SBT, and at the successful completion of SBT. Succeeded (group S) and failed individuals (group F, who needed reintubation within 48 hours) were compared. The sensitivity, specificity, and area under the receiver operating curve were calculated. A subgroup of patients with cardiac comorbidities and impaired cardiac contractility was further analyzed.MEASUREMENTS AND MAIN RESULTS:The authors included 39 critically ill patients for weaning from MV. The reintubation rate was 54.8%. In patients with cardiac morbidity, delta change (dC) in PV and COP as predictors of WF showed 100% sensitivity and specificity, with 18% and 14% cut-offs after initiating the SBT (dC between the beginning and end of the successful SBT), respectively. Central venous oxygen saturation revealed a significant difference between patients with cardiac morbidity and noncardiac patients with lower sensitivity and specificity in the prediction of WF.CONCLUSIONS:TED could be a helpful method for the weaning of patients with cardiac morbidity from MV. The dC in PV and COP >18% and >14% were significant predictors of WF in these subjects, respectively.

Introduction and objectives: To study the impact of injecting intracoronary eptifibatide plus vasodilators via thrombus aspiration catheter vs thrombus aspiration alone in reducing the risk of no-reflow in acute ST-elevation myocardial infarction (STEMI) with diabetes and high thrombus burden. Methods. The study involved 413 diabetic STEMI patients with high thrombus burden, randomized to intracoronary injection (distal to the occlusion) of eptifibatide, nitroglycerin and verapamil after thrombus aspiration and prior to balloon inflation (n = 206) vs thrombus aspiration alone (n = 207). The primary endpoint was post procedural myocardial blush grade and corrected Thrombolysis in Myocardial Infarction (TIMI) frame count (cTFC). Major adverse cardiovascular events were reported at 6 months. Results. The intracoronary eptifibatide and vasodilators arm was superior to thrombus aspiration alone regarding myocardial blush grade-3 (82.1% vs 31.4%; P= .001). The local intracoronary eptifibatide and vasodilators arm had shorter cTFC (18.16 +/- 6.54 vs 29.64 +/- 5.53, P = .001), and better TIMI 3 flow (91.3% vs 61.65%; P = .001). Intracoronary eptifibatide and vasodilators improved ejection fraction at 6 months (55.2 +/- 8.13 vs 43 +/- 6.67; P = .005). There was no difference in the rates of major adverse cardiovascular events at 6 months. Conclusions. Among diabetic patients with STEMI and high thrombus burden, intracoronary eptifibatide plus vasodilators injection was beneficial in preventing no-reflow compared with thrombus aspiration alone. Larger studies are encouraged to investigate the benefit of this strategy in reducing the risk of adverse clinical events. (C) 2021 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.

Context Regulatory T cells have an immunosuppressive function on T-cell activation. They are involved in pathophysiology and treatment of immune thrombocytopenia (ITP). Circulating myeloid-derived suppressor cells (MDSCs) are involved in immune dysregulation in ITP. Aim To determine the mean level of MDSCs in acute, persistent, and chronic ITP and its effect on treatment modalities and prognosis. Patients and methods A total of 41 patients with ITP were recruited from the pediatric hematology clinic of Ain Shams University. They were classified into acute, persistent, and chronic and were compared with 20 age-matched and sex-matched healthy controls. All patients were subjected to history taking with emphasis on age of presentation, disease duration, and treatment modalities, as well as thorough clinical examination. Mean values of C-reactive protein, alanine aminotransferase, and serum creatinine were collected from the patients' files. All study participants underwent complete blood count (Coulter) and MDSCs by flow cytometry. Secondary thrombocytopenia was excluded. Results Acute ITP was detected in 29%, 24% had persistent, and 46% had chronic ITP. Their age ranged from 1 to 16 years at the study entry, and 51.2% were male. Active disease was found in 58.5%, whereas 41.4% in remission. No treatment was offered to 53%, whereas 24% of patients were on steroids. MDSCs decreased significantly in patients with ITP compared with the control group (P<0.001), whereas there was no significant difference among the patient groups regarding MDSCs level (P=0.325) or with different treatment modalities. Conclusion Reduced numbers of MDSCs play a role in pathogenesis of ITP. Yet, MDSCs did not differ according to disease duration or treatment modalities.

Background: Complete revascularization of significant non culprit lesions is associated with better outcomes in ST Elevation Myocardial Infarction (STEMI) patients regarding Major Adverse Cardiac Events (MACE), however the incidence of Contrast Induce Nephropathy (CIN) in diabetic and elderly patients is unclear. Objectives: To investigate whether an index procedure complete revascularization approach is associated with increased risk of CIN in diabetic elderly patients presented with STEMI and multi-vessel disease. Methods: This study enrolled 140 diabetic elderly patients with acute STEMI and at least one non-culprit lesion, randomized to either complete revascularization (n=70) or culprit-only treatment (n=70). Complete revascularization was performed at the time of Primary Percutaneous Coronary Intervention (PPCI). The primary endpoint was the incidence of CIN or renal dialysis at one month. Results: A complete revascularization approach was significantly associated with higher risk of CIN (21.4% vs. 7.1; p=0.01), with no significant difference in the other endpoints of mortality, renal replacement therapy, major or minor bleeding between the groups. Conclusion: In diabetic elderly STEMI patients, with multi-vessel coronary artery disease undergoing PPCI, complete revascularization during index procedure is associated with significantly higher risk of CIN, compared with culprit vessel only PCI.

BACKGROUND:Caudal anesthesia is an effective method of pain management, which can be successfully employed to minimize post-thoracotomy pain in pediatric patients. However, its main disadvantage is the short postoperative analgesic period, which can be prolonged by the concurrent administration of one of many adjuvants.OBJECTIVES:This prospective randomized, blinded study aimed to compare the efficacy of dexmedetomidine versus morphine as adjuvants to bupivacaine in caudal anesthesia for thoracic surgeries in pediatric patients.METHODS:Fifty patients were randomly allocated into two equal groups. To achieve caudal epidural block anesthesia, the patients in group M (n = 25) were administered morphine and bupivacaine, while group D (n = 25) received a mixture of dexmedetomidine and bupivacaine. The primary outcome of this study was the postoperative analgesic duration achieved. The secondary outcomes included morphine administration in the first 24 hours following caudal block anesthesia, the face, legs, activity, cry, consolability (FLACC) scale scores, and adverse effects, including vomiting, itching, bradycardia, hypotension, and respiratory depression.RESULTS:The results showed that patients who had received dexmedetomidine achieved a longer postoperative analgesia as compared to those who had received morphine (P < 0.001). Postoperatively, the heart rate, blood pressure, pain score, and mean consumption of morphine were lower in group D as compared to the group M. There was no significant difference in the adverse effects between the two groups.CONCLUSIONS:The use of dexmedetomidine as an adjuvant to bupivacaine for caudal anesthesia during pediatric thoracic surgeries induced better and prolonged postoperative analgesia as compared to morphine.

SARS-CoV-2 currently lacks effective first-line drug treatment. We present promising data from in silico docking studies of new Methisazone compounds (modified with calcium, Ca; iron, Fe; magnesium, Mg; manganese, Mn; or zinc, Zn) designed to bind more strongly to key proteins involved in replication of SARS-CoV-2. In this in silico molecular docking study, we investigated the inhibiting role of Methisazone and the modified drugs against SARS-CoV-2 proteins: ribonucleic acid (RNA)-dependent RNA polymerase (RdRp), spike protein, papain-like protease (PlPr), and main protease (MPro). We found that the highest binding interactions were found with the spike protein (6VYB), with the highest overall binding being observed with Mn-bound Methisazone at −8.3 kcal/mol, followed by Zn and Ca at −8.0 kcal/mol, and Fe and Mg at −7.9 kcal/mol. We also found that the metal-modified Methisazone had higher affinity for PlPr and MPro. In addition, we identified multiple binding pockets that could be singly or multiply occupied on all proteins tested. The best binding energy was with Mn–Methisazone versus spike protein, and the largest cumulative increases in binding energies were found with PlPr. We suggest that further studies are warranted to identify whether these compounds may be effective for treatment and/or prophylaxis.

Background: World Health Organization (WHO) declared Coronavirus disease 2019 (COVID-19) as a pandemic in March 2020. Such widespread outbreaks are associated with adverse mental health consequences. Aims: To evaluate mental health outcomes among Egyptian healthcare workers (HCW) treating patients with confirmed or suspected Coronavirus Disease 2019 (COVID-19) to direct the promotion of mental wellbeing, by screening for symptoms of anxiety, insomnia, depression and stress, and analyzing potential risk factors. Methods: This cross-sectional, hospital-based survey study collected demographic data and mental health measurements from 502 HCW dealing with COVID-19. HCW were surveyed in 20 hospitals (Fever, Chest, and Quarantine hospitals) in different parts of Egypt, in April and May 2020. Results: Among the 502 HCW surveyed; 60.0% were physicians, 16.1% were specialized nurses, and 23.9% were non-specialized nurses. About 35.3% worked in chest hospitals, 17.5% in fever hospitals, and 47.2% in quarantine hospitals. A considerable proportion of HCW had symptoms of anxiety, insomnia, depression, and stress. Females were at higher risk of experiencing symptoms of severe anxiety (odds ratio [OR], 1.85; 95% CI, 1.12–3.05; p = .016), severe depression (OR, 2.013; 95% CI, 1.17–3.4; p = .011), and severe stress (OR, 2.68; 95% CI, 1.5–4.6; p < .001). Fever hospital workers were at higher risk of severe depression (OR, 1.52; 95% CI, 1.11–2.09; p < .01), compared to Quarantine hospital workers. Conclusion: Ensuring proper mental health support for HCW is an important component of public health measures for addressing the COVID-19 epidemic and safeguarding the continuity of appropriate medical service.

Peanut (Arachis hypogaea L.) One of the most important leguminous crops is due to the high nutritive value of its seeds while rich in protein (up to 30%) and oil% from 38 to50%. Recently has been a resurgence of interest in environmental friendly, sustainable and organic agricultural practices. Two field experiments were layout in provide farm at Orabi Association Farm, Ismailia high way, Egypt during the two season (2017-2018) using bio fertilizer which have some microorganisms had the ability to convert elements to available nutrient for plant’s roots. Adding the drinking water purification residual (DWPR or Rouba) as a source for Bio-organic natural (some elements, microorganisms...etc.).In combination with or without natural mineral rocks as a source for natural forms of elements (P and K). The study included 8 fertilizer treatments, (T1)full dose of mineral N P K fertilizer (T2) rouba at 20m 3 fad, (T3) rouba 30 m 3 fad, (T4) rouba 20m 3 fed + NR, (T5) rouba 30m 3 fed+ NR, (T6) natural rock (NR)+ bio fertilizer, (T7) rouba 20m 3 fed + NR + bio fert. and (T8) rouba 30 m 3 fed + NR+ (bio fert.) were treated under sandy soil conditions. The obtained result clearly indicated that the experimental side have a few number of nodules formed on roots of peanut plants and application of various fertilizer treatments have a positive effect on nodules formed and led to scored significant increases between them. Application of bio fertilizers, NR in combination with rouba gave higher values for the most of growth and yield parameters tested. The results revealed that the treatment which received rouba at 30m fed +NR in combination with bio fertilizers had a superior plant in the growth and chemical characteristics (number of nodules, plant dry weight, N Percentage and plant-N content) as well as yield parameters yield of pod g plant & ton fed, seed yield g plant& ton fed, seed index, shelling% and oil and protein content (%). Application of the fertilizer treatment which received rouba 30m+ NR + bio fertilizer as a safe, finally environment and cheap in agricultural practices for advantage that contribute to improve productivity quality and producing safe crop in addition to pressure the environment.

Objectives: Tracheostomy is a very common clinical intervention in critically ill adult patients. The indications for tracheostomy procedures in pediatric patients with complex conditions have increased dramatically in recent years, but there are currently no guidelines on the optimal timing of tracheostomy in pediatric patients undergoing prolonged ventilation. Data Sources: We performed a systematic search of the existing literature in MEDLINE via PubMed and Embase databases and the Cochrane Library to identify clinical trials, observational studies, and cohort studies that compare early and late tracheostomy in children. The date of the last search was August 27, 2018. Included articles were subjected to manual searching. Study Selection: Studies in mechanically ventilated children that compared early with late tracheostomy were included. Data Extraction: Data were extracted into a spreadsheet and copied into Review Manager 5.3 (The Cochrane Collaboration, Copenhagen, Denmark). Data Synthesis: Data were meta-analyzed using an inverse variance, random effects model. Continuous outcomes were calculated as mean differences with 95% CIs, and dichotomous outcomes were calculated as Mantel-Haenszel risk ratios with 95% CIs. We included eight studies (10 study arms). These studies were all retrospective cohort studies. Early tracheostomy was associated with significant reductions in mortality, days on mechanical ventilation, and length of intensive care and total hospital stay, although the lack of randomized, controlled trials limits the validity of these findings. Although variance was imputed for some studies, these conclusions did not change after removing these studies from the analysis. Conclusions: In children on mechanical ventilation, early tracheostomy may improve important medical outcomes. However, our data demonstrate the urgent need for high-quality, randomized controlled trials in the pediatric population.

Introduction: Many pharmaceutical, surgical, and complementary medical interventions are used for primary dysmenorrhea treatment. However, no consensus has been reached about the most effective intervention. Objective: To compare the efficacy and safety of IV tramadol versus IV paracetamol in relieving acute pain of primary dysmenorrhea. Methods: This randomized controlled trial was conducted in a tertiary referral hospital and included 100 patients between 18 and 35 years old diagnosed with primary dysmenorrhea. Patients received either 1-g paracetamol or 100-mg tramadol in 100-mL normal saline as an IV infusion over 10 min. Pain intensity was measured by using a visual analog scale at 15, 30, 60 min, and 2 h. We recorded drug side effects and requirements for rescue analgesics. Results: Pain scores were significantly lower in the tramadol group compared with the paracetamol group at 15, 30, 60 min, and 2 h (p < 0.001). Fewer patients in the tramadol group needed rescue analgesics compared with the paracetamol group (p = 0.04). No significant differences were reported in side effects between both groups. Conclusions: IV tramadol is superior to IV paracetamol in relieving acute pain of primary dysmenorrhea with a comparable side effect profile.

Background Multimodal perioperative analgesia including acetaminophen is recommended by current guidelines. The comparative efficacy of intravenous vs oral acetaminophen in sinus surgery is unknown. We aimed to determine whether intravenous or oral acetaminophen results in superior postoperative analgesia following sinus surgery. Methods This was a prospective randomized trial with blinded endpoint assessments conducted at a single large academic medical center. Subjects undergoing functional endoscopic sinus surgery were randomized to intravenous vs oral acetaminophen in addition to standard anesthetic and surgical care. The primary outcome was visual analogue scale pain score at 1 hour postoperatively. Results One hundred and ten adult patients were randomized; 9 were excluded from the data analysis. Fifty patients were assigned to intravenous acetaminophen and 51 to oral acetaminophen. Postoperative pain scores at 1 hour (primary endpoint) were not significantly different between the intravenous and oral acetaminophen groups. Similarly, there was no significant difference in pain scores at 24 hours postoperatively. Finally, there was no significant difference in postoperative opioid usage in the postanesthesia care unit or over the first 24 hours postoperatively. Conclusions This is the first comparative efficacy trial of oral vs intravenous acetaminophen in sinus surgery. There was no significant difference in pain scores at 1 or 24 hours postoperatively, and no difference in postoperative opioid use. Intravenous acetaminophen offers no apparent advantage over oral acetaminophen in patients undergoing sinus surgery. Level of Evidence 1b