Platelet Indices as a marker of severity in Acute Coronary Syndrome patients at Qena University Hospital

Background: Coronary artery disease (CAD) is the leading global cause of death, with acute coronary syndrome (ACS) being a severe form leading to myocardial injury. Platelets and lipids play a key role in thrombosis and atherogenesis. Complete blood count (CBC) ratios may predict ACS outcomes. Objectives: To assess the relationship between platelet and inflammatory indices and the severity of ACS. Patients and methods: This cross-sectional study involved ACS patients aged 18+. Patients were divided into groups 1 (stable CAD) and 2 (acute myocardial infarction). Clinical and laboratory assessments included ECG, echocardiography, CBC, cardiac enzymes, and inflammatory markers. Results: Cases had significantly higher systolic blood pressure; ECG was abnormal in 95%. ST depression was present in 59% of patients, 53% had an ejection fraction (EF) of less than 50%; and the mean EF was 48.09±8.93%. Patients with EF<50% had higher platelet count (336.962±73.198 vs 246.83±54.308, P<0.0001) and increased inflammatory indices (P < 0.05), but lower mean platelet volume (MPV) (8.91±2.72 vs 11.92±3.57, P<0.0001) and lymphocyte count (2.551±1.211 vs 2.989±1.298, P=0.0297). Neutrophil platelets score (NPS) and prognostic index (PI) scores of 1 and 2 were more prevalent among ACS cases with EF of < 50% (P<0.05). Platelet distribution width (PDW) and systemic immune-inflammation index (SII) were independent positive predictors of left ventricular ejection fraction (LVEF) (P<0.0001), whereas C-reactive protein (CRP) level was a significant independent negative predictor (P<0.0001). Conclusion: Hematologic inflammatory indices and EF were correlated in ACS patients; higher ratios are associated with systemic inflammation and reduced EF

Red Cell Osmotic Fragility Status and its Contributing Factors in Type 2 Diabetes Mellitus Patients at South Valley University Hospital

Background: Diabetes mellitus (DM) is a growing public health issue in Egypt. Chronic hyperglycemia, impaired erythropoietin production, and increased RBC fragility, lead to increased destruction. Objective: To assess the red cell osmotic fragility status and its determinants in type 2 DM (T2DM) patients. Patients and methods: A cross-sectional study involving 200 participants, 100 with T2DM, and 100 controls, subjected to clinical, physical examination, and laboratory investigations, including an osmotic fragility test. Results: Anemia was prevalent in 56% of T2DM; 93% had HbA1c > 7, a higher rate of infection, and the presence of complications and associated comorbidities. Anemic patients have higher WBC, platelets, reticulocyte counts, CRP, and ferritin; hemolysis starts at higher NaCl%, especially in females. Hemolysis is linked to various health indicators, including age, disease duration, blood pressure, red cell indices, inflammatory markers, kidney function, and lipid levels. The HbA1c positively correlated with disease duration (r=0.3321, p=0.001), systolic BP (r=0.3342, p=0.001), serum creatinine (r=0.456, p < 0.00001), cholesterol (r=0.5552, p < 0.00001), and VLDL (r=0.3342, p=0.001), and negatively correlation with diastolic BP (r=-0.3318, p=0.001), MCV (r=-0.317, p=0.001), triglycerides (r=-0.3212, p=0.001), and eGFR (r=-0.2391, p=0.0166). Conclusion: Anemia was prevalent in T2DM patients, accompanied by the presence of comorbidities and complications. Poor glycemic control leads to a decline in RBC count, indices, and increased fragility, which may exacerbate disease progression and worsen complications. Regular monitoring and strict glycemic control aid in complication prevention

Numerical Simulation of 3D- Flow Structure and Heat Transfer for Longitudinal Riblet Upstream of Leading Edge Endwall Junction of Nozzle Guide Vane

The simulation have been made for  3D flow structure and heat  transfer with and without longitudinal riblet upstream of leading edge vane endwall junction of first stage nozzle guide vane .The research explores concept of weakening the secondary flows and reducing their harmful effects.Numerical investigation involved examination of the secondary flows ,velocity and heat transfer rates by solving the governing equations (continuity, Navier -stokes and energy equations ) using the known package FLUENT version (12.1).The governing equations were solved for three dimentional, turbulent flowe, incompressible with an appropriate turbulent model (k-ω,SST) .The numerical solution was carried out for 25 models of V-groove riblet with wide ranges of height (h) and space (s). The results indicated that, the riblet endwall junction was a powerful tool for controlling the flow structure, reducing secondary flow formation,and elimination the effect of heat transfer at leading edg and passage . The drag reduction produced by riblet was proportional with their height and space. V-groove riblet with dimension of (h=1.35mm and s=2.26mm) was found to be the most effective in reduction of drag (2.7%) and heat transfer (21%) so it was selected as an optimum dimension of riblet model. The results also showed that the drag reduction produced by riblet was proportional to their size. The riblet model had a great effect in elimination spanwise ,pitchwise velocities ,but strength the streamwise velocity .At leading edge ,the effect of secondary flow was extended up to 23% from span height and 35% upstream leading edge .The riblet model caused an increase in momentom at a region very close to leading edge and to move stagnation point very close to the leading edge

The Role of Prolactin as a Disease Activity Indicator in Some Rheumatic Diseases

Background: Autoimmune rheumatic diseases, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and scleroderma, predominantly affect women and are characterized by systemic inflammation, leading to organ failure. Prolactin (PRL), a hormone produced by the pituitary gland and lymphocytes, significantly affects immune regulation and is implicated in the pathophysiology of these diseases. Objectives: This study aimed to evaluate the relationship between PRL levels and disease activity in RA, SLE, and scleroderma. Patients and methods: A cross-sectional case-control study involved 150 premenopausal women (50 with RA, 30 with SLE, and 20 with scleroderma) and 50 age-matched healthy controls. Clinical disease activity assessments (DAS28 for RA, SLEDAI for SLE, and MRSS for scleroderma) and laboratory estimation of serum PRL level were conducted. Results: The mean PRL levels in RA (26.17 ng/ml), SLE (25.23 ng/ml), and scleroderma (32.07 ng/ml) were significantly higher than controls (15.48 ng/ml) (P < 0.001). 42% of RA patients, 30% of SLE patients, and 50% of scleroderma patients had elevated PRL levels. Hyperprolacinemia is correlated with disease activity (DAS28 (r = 0.493, p = 0.0001), SLEDAI (r = 0.546, p = 0.002), and MRSS (r = 0.893, p = 0.0001), respectively). Conclusion: Serum PRL levels were significantly elevated in RA, SLE, and scleroderma, which is consistent with disease activity scores. Regular monitoring may be necessary because of the potential of PRL to function as a marker of disease activity. The therapeutic potential of dopamine agonists in autoimmune diseases warrants further investigation, as they have the potential to reduce flare-ups and organ involvement

Integrating Complementary and Alternative Medicine into Family Medicine Practice: Narrative Review

Complementary and Alternative Medicine (CAM) has witnessed a significant surge in usage across various populations and regions in recent decades. This review article delves into the prevalence and patterns of CAM usage, from cancer patients to cultural practices in Saudi Arabia and New Zealand. In Saudi Arabia, CAM practices, especially spiritual ones like prayer and reciting the Quran, are widely adopted, with herbs, honey, and dietary products also being popular. New Zealand healthcare professionals, including general practitioners and midwives, generally hold a positive view towards CAM, with acupuncture being particularly favored. However, concerns about CAM's scientific evidence, safety, and costs persist. In the U.S., while CAM is popular, many family physicians feel inadequately trained to address CAM-related patient queries. In Germany, a significant number of family physicians use CAM in their practices, emphasizing the need for increased CAM education and research. The data underscores the global trend of CAM adoption and the need for its effective integration into mainstream healthcare. Despite its popularity, the integration of CAM in medical education remains limited in many regions, including Saudi Arabia. However, there's a noticeable shift with some medical schools beginning to incorporate CAM into their curriculum. The article underscores the importance of evidence-based practice, education, training, open communication, regulation, interdisciplinary collaboration, a patient-centered approach, thorough documentation, continuous research, cultural sensitivity, and cost-effectiveness evaluation when considering the integration of CAM into mainstream healthcare. The recommendations provided aim to ensure that patients receive holistic care that is both safe and effective. The overarching theme is the need for a balanced, informed, and collaborative approach to integrating CAM into family medicine practice

Molecular identification and histopathological of Cysticercus tenuicollis infestation among small ruminants

Small ruminant infections by the Cysticercus tenuicollis result in financial losses because of the condemnation of infected organs, which can happen in unsanitary conditions and is regarded as an ecotoxicological risk factor. Therefore, a cross-sectional study was conducted to investigate the infection rate of Cysticercus tenuicollis, risk factors, and morphological, histological, biochemical, and molecular characterization of the genetic sequence of cysts collected from the affected organs of 139 sheep and 261 goats in the Allam-ELrom abattoir, Matrouh Governorate, Egypt. The overall infection rate was 19.25%, with a higher prevalence in goats, 23.40%, compared to sheep, 11.50%, indicating that species served as a significant risk factor for infection. However, no notable significant differences in infection rates were observed based on age or sex, with the main symptoms being pulmonary crackles by auscultation and visceral pain. The cysts were most frequently found in the omentum, 72.76%, followed by the liver, 18.18%. There were significant differences in biochemical parameters, such as liver enzymes and lipid profiles of the cyst fluid, among different organs. Molecular identification through PCR and sequence investigation of the cox1 gene in goats and 12S rRNA in sheep confirmed the cysts as C. tenuicollis. The retrieved sequences (OL470129 for sheep and OL470130 for goats) were nearly identical to those reported from other countries, highlighting the genetic similarity of this parasite across regions

Impact of aortic angulation on outcomes in transcatheter aortic valve replacement with balloon-expandable and self-expanding valves: a systematic review and meta-analysis.

High aortic angulation (AA) can pose significant challenges during TAVR. This meta-analysis determines the impact of a horizontal aorta on TAVR outcomes with balloon-expandable (BEV) and self-expanding valves (SEVs). A comprehensive search was conducted from inception to June 2024. Thirteen observational studies assessing the impact of aortic angulation in patients undergoing TAVR replacement were included. The pooled results indicated that short-term mortality was significantly lower in patients with a non-horizontal aorta (RR = 0.76; 95% CI 0.62-0.95, P = 0.01). Subgroup analysis displayed that BEVs had a lower short-term mortality with a horizontal aorta than SEVs. The incidence of stroke was not significantly affected by aortic angulation with either valve type. However, the overall risk of permanent pacemaker implantation was lower in patients with a non-horizontal aorta for both valve types. Paravalvular regurgitation was also reduced in the non-horizontal aorta group, with no difference between aortic angulations in patients with BEVs. In contrast, SEVs favored a non-horizontal aorta in reducing paravalvular leak (RR = 0.66; 95% CI 0.46-0.94, P = 0.02). Both BEVs and SEVs show better results in patients with lower aortic root angulation. The increased incidence of conduction abnormalities and PPI rates with both valve types in patients with horizontal aorta is a concern. BEVs could be potentially used preferentially to SEVs in patients with a horizontal aorta as there was no difference between horizontal and non-horizontal aorta groups regarding short-term mortality, moderate-to-severe paravalvular leak, and need for a second valve

Genetic diversity and antibiotic resistance of Mycobacterium bovis in bovines in the Delta area of Egypt

IntroductionMycobacterium bovis (M. bovis) causes significant financial harm to the cattle industry through decreased productivity and trade limitations, while also posing a risk to human health through zoonotic transmission, which is primarily from unpasteurized milk or close animal contact.MethodsSingle intradermal tuberculin was used to test 2400 cases (1000 Holstein Friesian cattle and 1400 native breed buffaloes) during the national control program from Cairo, El-Buhaira, Dakahlia, Gharbia, Menoufia, and Sharkia districts located at the northern areas of Egypt. Tuberculin-positive cases were slaughtered and subjected to postmortem examination and isolation of M. bovis was performed. IS6110 primer was used in PCR test to confirm the existence of genus mycobacterium and regions of difference-based differentiation was used to detect M. bovis on the species level, phenotypic and genotypic antimicrobial resistance, as well as mycobacterial interspersed repetitive unit-variable number tandem repeat analysis (MIRU-VNTR) were performed.ResultsA total of 65 out of 2400 (2.7%) cases were single intradermal tuberculin test positive, 40 out of 65 (61.53%) were M. bovis positive on PCR, and the 40 isolates exhibited susceptibility to ethambutol, rifampicin, streptomycin, ciprofloxacin, levofloxacin, ofloxacin, and sparfloxacin. From them, 32 (80%) were susceptible to isoniazid, and 8 (20%) were resistant. These eight isolates contained three distinct katG mutations at codons 315, 463, and 506 with rates of 2/8 (25%), 3/8 (37.5%), and 3/8 (37.5%), respectively each representing a unique, single-codon mutation. MIRU-VNTR analysis enabled the identification of 35 distinct genotypes, with genotypes 26, 27, and 28 showing high prevalence. The nine highly discriminatory loci MIRU10, QUB11b, MIRU26, QUB26, QUB4156, MIRU04 ETRD, ETRA, Mtub30, and Mtub39 with a discriminating index of 0.9676 were suitable for the preliminary genotyping of M. bovis isolates from animals. M. bovis, ID: 7540/01, Lineage: Bovis and ID: 951/01, Lineage: Bovis from Germany were the closest lineages to our genotypes using the MIRU-VNTR plus database.ConclusionM. bovis isolated from cattle and buffaloes of some Delta area districts expressed high diversity and some isolates showed resistance to isoniazid with katG mutations. Continuous implementation of MIRU-VNTR analysis will help to trace the origin and similarities among animal and human isolates within the Delta area

Integrated biofloc technology in red tilapia aquaculture: Salinity-dependent effects on water quality, parental stock physiology, reproduction, and immune responses

The study examines the impact of integrated biofloc technology (BFT), different salinity levels, and their combined effects over 90 days on various physiological parameters. The investigation includes growth performance and feed utilization, water quality, the chemical composition of biofloc and fish, digestive enzymes, reproductive performance, stress and biochemical indicators, and antioxidant-immune responses in red tilapia (Oreochromis spp.) broodstock. The fish were initially weighed (males: n = 270; 104 ± 0.96 g; females: n = 270; 93.2 ± 0.66 g) and subsequently divided into 12 treatment groups (6 for males and 6 for females) spread across 36 separate tanks (3 tanks per treatment; 45 fish per treatment; 15 fish/tank). The treatments involved three salinity levels (18, 28, and 36 ppt) in both clear water (CW) and BFT systems. The outcomes demonstrated that fish in the 36 ppt salinity with BFT treatment demonstrated significant improvements (P < 0.05) in growth parameters (final body weight, weight gain, and specific growth rate, feed intake, and feed conversion ratio). The condition factor in BFT groups increased in all salinity situations. The survival rates of broodstock were consistently high in all experimental conditions The study found that BFT and salinity significantly impacted (P < 0.05) whole body contents (moisture, protein, lipid, and ash) in both males and females. Water quality parameters showed variations between BFT and CW, with notable impacts (P < 0.05) on dissolved oxygen and pH. The BFT and salinity influenced digestive enzyme activities (protease, amylase, and lipase) and reproductive performance (males) and the 36 ppt salinity with BFT recorded the highest values. The hemato-biochemical and antioxidant-immune responses were also impacted by BFT and salinity exposure. The study highlights the potential benefits of incorporating BFT into red tilapia aquaculture systems, particularly in optimizing growth, health, and reproductive performance under various salinity conditions, which can enhance sustainable intensification, disease control, and environmental stewardship

Effect of high parity on occurrence of anemia in pregnancy: a cohort study

<p>Abstract</p> <p>Background</p> <p>Studies that explore the controversial association between parity and anaemia-in-pregnancy (AIP) were often hampered by not distinguishing incident cases caused by pregnancy from prevalent cases complicated by pregnancy. The authors' aim in conducting this study was to overcome this methodological concern.</p> <p>Methods</p> <p>A retrospective cohort study was conducted in Oman on 1939 pregnancies among 479 parous female participants with available pregnancy records in a community trial. We collected information from participants, the community trial, and health records of each pregnancy. Throughout the follow-up period, we enumerated 684 AIP cases of which 289 (42.2%) were incident cases. High parity (HP, ≥ 5 pregnancies) accounted for 48.7% of total pregnancies. Two sets of regression analyses were conducted: the first restricted to incident cases only, and the second inclusive of all cases. The relation with parity as a dichotomy and as multiple categories was examined for each set; multi-level logistic regression (MLLR) was employed to produce adjusted models.</p> <p>Results</p> <p>In the fully adjusted MLLR models that were restricted to incident cases, women with HP pregnancies had a higher risk of AIP compared to those who had had fewer pregnancies (Risk Ratio, RR = 2.92; 95% CI 2.02, 4.59); the AIP risk increased in a dose-response fashion over multiple categories of parity. In the fully adjusted MLLR models that included all cases, the association disappeared (RR = 1.11; 95% CI 0.91, 1.18) and the dose-response pattern flattened.</p> <p>Conclusions</p> <p>This study shows the importance of specifying which cases of AIP are incident and provides supportive evidence for a causal relation between parity and occurrence of incidental AIP.</p