Health innovations in response to the COVID-19 pandemic: perspectives from the Eastern Mediterranean Region.

BACKGROUND: This paper aims to document the numerous health innovations developed in response to the COVID-19 crisis in the Eastern Mediterranean Region (EMR) using a scoping review approach. METHODS: A literature search was conducted using PubMed, the Eastern Mediterranean Health Journal, the Index Medicus for EMR to identify peer-reviewed articles between December 2019 and November 2020 and WHO and ministries of health websites for grey literature. Following an initial review, full-text screening identified studies reporting on health innovations in response to the COVID-19 pandemic in the region. RESULTS: This review describes 82 health innovations reported from 20 countries across the region: 80% (n = 66) were digital and technology-based products and services including health care delivery (n = 25), public health informatics (n = 24) and prevention (n = 17); 20% (n = 16) were innovative processes including health care delivery (n = 8), educational programmes (n = 6) and community engagement (n = 2). CONCLUSION: The speed with which these technologies were deployed in different contexts demonstrates their ease of adoption and manageability and thus can be considered as the most scalable. Strengthened frameworks to protect users' privacy, documentation and evaluation of impact of innovations, and training of health care professionals are fundamental for promoting health innovations in the EMR.

A descriptive study of inflammatory bowel disease at an Egyptian tertiary care center.

INTRODUCTION AND AIMS: Inflammatory bowel disease (IBD) is a group of chronic intestinal disorders that trigger prolonged inflammation of the digestive tract. Its incidence and prevalence appear to be increasing in the African population and in Egypt. The present study aims to highlight the pattern and management of IBD in Egyptian patients. MATERIALS AND METHODS: Two hundred patients with IBD were assessed for ulcerative colitis (UC), through the Mayo score, and for Crohn's disease (CD), with the Crohn's disease activity index (CDAI). RESULTS: Median patient age was 35 years, with a predominance of females. UC was more common than CD (88% and 12%, respectively) and severity was moderate, in the majority of cases. Most UC patients had left-sided lesions, whereas ileitis was the most common finding (37.5%) in the CD patients. Proctitis was the least common finding in both diseases and Crohn's fistulizing disease was detected in 4.1% of the patients. Interestingly, peripheral arthropathy was the most common extraintestinal manifestation in the IBD patients (70%) and axial arthropathy was the least common (6%). Severe ocular or mucocutaneous involvement was very rare. Finally, biologic treatment was prescribed to 15.4% of the UC patients and 20.8% of the CD patients. CONCLUSIONS: Although the clinical presentation of IBD in Egypt is comparable to that reported worldwide, diagnoses were found to be delayed. There were fewer cases of CD than UC, but more mild-to-moderate disease severity. The surveillance of patients with IBD must continue and awareness of the disease in the Egyptian medical community needs to increase. A national registry must be established, multicenter studies need to be conducted, and molecular diagnostics is recommended.

Implementing group research assignment in undergraduate medical curriculum; impact on students' performance and satisfaction.

BACKGROUND: Medical educators need to integrate research skills within undergraduate medical curriculum to help students perceive their relevance to routine doctor's practice. The current work aimed to assess the impact of including group research assignment in the endocrine module to third year medical students on attaining some research, communication and E learning skills and on their performance in the module. METHODS: Students carried out a group research activity (N = 10), wrote a report and presented their work as a poster, booklet or video clip. Multiple evaluation methods were used; a questionnaire to assess students' satisfaction and perception towards the skills acquired and a rubric to grade the research report and presentation. Also, students' final grades in the module were compared with that of the previous cohort who didn't conduct the research assignment. RESULTS: Students' response rate to the questionnaire was 50%. 73.6% of students agreed that research enhanced critical evaluation of literature while 65.5% felt confident to further participate in research and 66.7% were satisfied about the whole research experience. Mean score of assignment was 84% for female students and 78% for male students. Grades of the current cohort in the endocrine module were significantly higher than that of the preceding cohort (78.7 ± 11 and 70.2 ± 13 respectively P< 0.001). CONCLUSION: The current study pointed to the positive impact of implementing group research assignment within the undergraduate medical curriculum. Students were satisfied about the research exposure, agreed attaining some skills and got higher grades than preceding peers.

Identifying barriers to the use of ultrasound in the perioperative period: a survey of southwestern Ontario anesthesiologists.

BACKGROUND: Ultrasound (US) can be used for many perioperative procedures, but evidence is lacking as to its frequency of use and barrier of application. The objectives of this survey were to determine i) how often US guidance was used perioperatively for vascular access placement, nerve blocks, and heart and lung assessment, and ii) to identify the barriers and the limitations of using US amongst anesthesiologists in southwestern Ontario. METHODS: We conducted a web-based survey in over 40 academic or community hospitals at southwestern Ontario. RESULTS: Of 266 surveys sent, 66 complete surveys were obtained (response rate of 25%). Most respondents (> 80%) reported that US was commonly used for central venous catheter (CVC) insertion, followed by regional blocks; the uses were less frequent for neuraxial blockade and cardiopulmonary assessment. Most respondents wanted to use US more frequently as part of their practice and felt that they already had adequate US training. However, most respondents (59%) reported limited access to US machines in their working institutes as being the major barrier to incorporating US in their daily practice. CONCLUSION: The most common uses of US in anesthesia practice in southwestern Ontario were for CVC insertion and regional blocks. Most anesthesiologists in southwestern Ontario are interested to incorporate US in their daily practice but most were limited by the lack of US resources. Apparently, only providing knowledge and skills teaching may not be sufficient to further improve the US utilization in our region; a matched administrative effort appears to be the next challenge.

Association of genetic polymorphisms of chemokines and their receptors with clearance or persistence of hepatitis C virus infection.

BACKGROUND: Polymorphisms of certain genes may have an effect on either persistence of infection or spontaneous clearance of hepatitis C virus (HCV). We hypothesized that one or more variants of chemokines (CCL2 and CCL5) and chemokine receptors (CC chemokine receptor type 2 [CCR2]) genes are associated with the susceptibility to HCV infection. METHODS: We recruited 1460 patients with chronic HCV (CHC), 108 subjects with spontaneous virus clearance (SVC) and 1446 individuals as a healthy control group. All were genotyped for single nucleotide polymorphisms: rs13900 C/T of CCL2, rs3817655 T/A of CCL5 and rs743660 G/A and rs1799864 G/A of CCR2 using allelic discrimination real-time PCR technique. RESULTS: The carriage of the A allele of CCR2 rs743660 was significantly higher in CHC compared to SVC (odds ratio [OR] 4.03) and to controls (1.42) and in controls compared to SVC (2.85) (all P < 0.01). Similarly, the A allele of CCR2 rs1799864 was significantly higher in the CHC group when compared with both SVC (1.97) and controls (2.13) (both P < 0.01), but the OR between controls and SVC was not significant (1.08, P = 0.723). Carriage of C allele of CCL2 rs13900 and the T allele of CCL5 rs3817655 were significantly higher in SVC group when compared with both CHC (OR = 0.19 and OR = 0.24, respectively) and control groups (OR = 0.65 and OR = 0.45, respectively [all P < 0.01]). CONCLUSIONS: Susceptibility to HCV infection is associated with A alleles of both (rs743660 and rs1799864 G/A) of CCR2 while spontaneous clearance of HCV is associated with the C allele of rs13900 of CCL2 and T allele of rs3817655 of CCL5.

Electrophotobiomodulation in the treatment of facial post-burn hypertrophic scars in pediatric patients.

Hypertrophic scar continues to be one of the leading reasons for surgical and non-surgical treatments after burn healing. Facial post-burn hypertrophic scars can cause severe functional and emotional disability, as they are usually difficult to conceal. Numerous nonsurgical and surgical therapies have been used for the treatment of hypertrophic scars. This study describes the combination of bipolar radiofrequency, intense pulsed light and cooling (given the collective term 'E-light'), and reports the outcomes of its use in the treatment of post-burn facial hypertrophic scars in a series of sixty-five patients in the pediatric age group. There were no reports in the literature of the use of this modality (E-light) in the treatment of facial post-burn hypertrophic scars in pediatric patients. Results showed that the mean decrease in total VSS score for all patients was 5.8. Regarding the satisfaction of the parents of our patients, 66.15% rated the result excellent, 24.61% rated it good and 9.23% rated it fair. We received no poor ratings for the final result, with a significant reduction in total Vancouver scar scale after treatment (P-value = 0.000). The E-light therapy technique studied in this work is effective, safe and economical if compared to other treatment modalities that can be used in the management of facial post-burn hypertrophic scars.

Les cicatrices hypertrophiques restent une des demandes majeures de traitement, chirurgical ou non, après cicatrisation d'une brûlure. Lorsqu'elles se situent au niveau du visage, elles entraînent des séquelles fonctionnelles et esthétiques majeure en raison de la difficulté de les masquer. De nombreuses options, chirurgicales ou non, sont possibles. Cette étude décrit la combinaison de radiofréquence bipolaire, lumière pulsée intense et refroidissement (connue sous la dénomination de "E-lumière") et ses résultats après utilisation pour traiter des cicatrices hypertrophiques du visage d'enfants cicatrisés de brûlures. On observe une réduction de 5,8 sur l'échelle de Vancouver (significative à p<0,0001). Les parents jugent le résultat excellent pour 66,15% d'entre eux, bon pour 24,61%, moyen pour 9,23%, aucun d'eux ne l'estimant mauvais. Le traitement par E-lumière est efficace, sûr et économique (comparativement à d'autres procédures) dans la traitement des cicatrices hypertrophiques après brûlure.

The association of single nucleotide polymorphisms of Toll-like receptor 3, Toll-like receptor 7 and Toll-like receptor 8 genes with the susceptibility to HCV infection.

BACKGROUND: Single nucleotide polymorphisms (SNPs) of Toll-like receptors (TLRs) are linked with functional modification of cytokine responses. In chronic hepatitis C virus (HCV) infection, studies of TLR polymorphisms have primarily targeted receptor pathways implicated in viral immune responses. We hypothesized that one or more variant(s) of TLR3, TLR7 and TLR8 are associated with different outcomes of HCV infection. MATERIALS & METHODS: A total of 3368 subjects from 850 families were recruited and divided into three main groups categorized as chronic HCV CHC spontaneous viral clearance (SVC), and controls. All individuals were genotyped for three SNPs for TLR3, two SNPs for TLR7, and two SNPs for TLR8 using allelic discrimination real-time PCR. RESULTS: Carriage of the C allele in three SNPs of TLR3 (rs3775290, rs3775291, and rs5743312), the C allele in TLR7 (rs3853839) in females only, and the C allele in TLR8 (rs3764879) in males only were significantly higher in SVC group than CHC group (P < 0.001), while carriage of the T allele in TLR7 (rs179008) in females only and the A allele in TLR8 (rs3764880) in both males and females were significantly higher in CHC infection more than SVC group (P < 0.001). CONCLUSION: The C allele is protective of HCV in TLR3, TLR7 (rs3853839) in females only, and TLR8 (rs3764879) in males only, while risk of infection is linked to the T allele in TLR7 (rs179008) in females only and the A allele in TLR8 (rs3764880) in both sexes.

Expression of the human gene CYP1A2 enhances tolerance and detoxification of the phenylurea herbicide linuron in Arabidopsis thaliana plants and Escherichia coli.

The phenylurea herbicide, linuron (LIN), is used to control various types of weeds. Despite its efficient role in controlling weeds, it presents a persistent problem to the environment. In the current study, phytoremediation properties of transgenic CYP1A2 Arabidopsis thaliana plants to LIN were assessed. CYP1A2 gene was firstly cloned and expressed in bacteria before proceeding to plants. In presence of LIN, The growth of CYP1A2 expressing bacteria was superior compared to control bacteria transformed with the empty bacterial expression vector pET22b(+). No clear morphological changes were detected on CYP1A2 transgenic plants. However, significant resistance to LIN herbicide application either via spraying the foliar parts of the plant or via supplementation of the herbicide in the growth medium was observed for CYP1A2 transformants. Plant growth assays under LIN stress provide strong evidence for the enhanced capacity of transgenic lines to grow and to tolerate high concentrations of LIN compared to control plants. HPLC analyses showed that detoxification of LIN by bacterial extracts and/or transgenic plant leaves is improved as compared to the corresponding controls. Our data indicate that over expression of the human CYP1A2 gene increases the phytoremediation capacity and tolerance of Arabidopsis thaliana plants to the phenylurea herbicide linuron.

Hypolipidemic and hepatoprotective activities of rosemary and thyme in gentamicin-treated rats.

Rosemary ( Rosmarinus officinalis; RM) and thyme ( Thymus vulgaris; TV) are used as remedies. We designed this work to investigate the preventive effect of aqueous extracts of RM or TV on the gentamicin (GM)-induced hepatotoxicity and abnormalities of lipid profile in rats. Both plant extracts exhibited an in vitro antioxidant activity as determined by the 1,1-diphenyl-2-picrylhydrazyl assay. Radical scavenging activity for TV extract was 48.7% and for RM extract was 25.6%. Polyphenolic determination by high-performance liquid chromatography for both extracts revealed that catechin, coumarin, cinnamic acid and rutin were detected in both extracts. RM extract had higher values than TV extract in all except rutin. Ferulic acid and quercetin were also detected in TV extract and sinapic acid and oleuropein were detected in RM extract. In rats given GM intraperitoneally for 10 days and coadministered either RM extract or TV extract orally, both aqueous extracts demonstrated similar hepatoprotective effects manifested by approximate normalization of plasma liver enzymes (AST and ALT), bilirubin level and total protein concentration compared with the group given GM only. Abnormal lipid parameters and raised hydrogen peroxide levels were ameliorated by both extracts. Pancreatic lipase activity was markedly reduced by RM extract. Also, the atherogenic index value was significantly reduced by both extracts as compared to that of GM group. DNA fragmentation analysis confirmed tissue damage by GM and its amelioration by the extracts. These findings suggest that RM and TV extracts could be helpful in ameliorating some aspects of gentamicin toxicity.

Therapeutic Role of Punica Granatum (Pomegranate) Seed Oil Extract on Bone Turnover and Resorption Induced in Ovariectomized Rats.

CONTEXT: Postmenopausal osteoporosis is mostly caused by increased bone remodeling resulting from estrogen deficiency. Hormone replacement therapy (HRT) is used to prevent osteoporosis, but it increases the risk for breast cancer, thromboembolism, strokes, and heart attacks. Pomegranate seed oil extract (SOE) is rich in phytoestrogen and antioxidant compounds. OBJECTIVES: To evaluate the therapeutic role of SOE against bone turnover, resorption and osteoporosis induced in ovariectomized rats as a postmenopausal model and comparing the results with those from Generic CycloProgynova drug (D). DESIGN: The study used western albino rats undergo bilaterally ovariectomization as a model for postmenopausal. SETTING: The study took part in a laboratory setting. ANIMALS: Forty female western albino rats (age: 3-4 months) weighing 150-180 gm. MEASUREMENTS: Rats were divided into four groups, 10 rats each; SC-group: Sham control = untreated and unovariectomized rats; OVX-group = ovariectomized rats; (OVX-SOE) and (OVX-D) groups = OVX rats were treated with SOE and D, respectively. Bone markers (BMs) especially osteocalcin (BGP), alkaline phosphatase (ALP), tartarate resistance acid phosphatase (TRAcP), bone weight, bone calcium concentration, serum electrolytes (calcium, sodium and potassium) and serum estradiol (E2) level and histopathological examination of bones were determined. Also lipid profile, uric acid, prothrombin time (INR) and liver and kidney functions were measured to evaluate the adverse effects of SOE and D. RESULTS: In OVX group the activities of ALP and TRAcP and the levels of BGP, serum calcium, sodium and body weight were significantly higher (p≤0.05) than SC-group, while bone calcium concentration, bone mass, serum E2 and potassium level as well as uterus mass were significantly lower (p≤0.05). Also histopathological results revealed that the outer cortical bone became thinner, while the cancellous bone trabeculae lost their normal architecture. Moreover in OVX group lipid profile and uric acid levels were significantly higher (p≤0.05) than SC group, but there were no significant changes (p≤0.05) in INR level, liver and kidney functions. Treatment of OVX rats with SOE or D for 12 weeks improved both the architecture of bones as shown from the histopathological results and BMs, serum electrolytes and E2 levels (p≤0.05) which approached SC-group. Moreover after treatment of OVX rats with SOE the levels of lipid profile and uric acid were improved and approached SC-group, while liver function became significant lower (p≤0.05) than SC-group. Also there were no significant changes (p≤0.05) in kidney functions and INR of (OVX-SOE), OVX and SC groups. In contrast in (OVX-D) group the levels of lipid profile, liver and kidney functions, uric acid and INR were significantly higher (p≤0.05) than those of OVX and SC groups. CONCLUSION: The results of this study show that SOE has therapeutic effects on osteoporosis, while it has no adverse effects on lipid profile, uric acid, liver and kidney functions when compared to HRT. SOE offers a promising alternative in the design of new strategies in nutritional management of age-related bone complications.

Integrated gasification combined cycle using Egyptian Maghara coal-rice straw feedstock.

Rice straw is an agricultural waste that causes an annoying problem in Egypt if it is not well exploited. This study focuses on using this waste in power generation by co-gasification of Egyptian Maghara coal and rice straw blends using entrained flow gasifier technology. Aspen Plus was used to conduct a parametric study for investigation of the effect of changing the inputs to the gasifier on the produced gas composition. Three different input parameters, influencing the performance of the gasifier, including the percentage of coal to rice straw in the blend, the fraction of added water to the blend, and the mass percentage of oxygen with respect to the mass of the blend fed to the gasifier were analysed. Two alternative power production schemes (with and without carbon capturing) have been investigated. The obtained optimum feed conditions are: 40% coal in the feed blend, 20% water concentration in the feed slurry, and 80% oxygen with respect to the dry feed blend to the gasifier. For (10 0000 kg per hour) of the feed blend, the power generated was 270.1 MW in the case of non-carbon capturing, while in the case of carbon capturing, 263.52 MW was generated. Although it produces less power, applying carbon capturing techniques means handling less flue gas and thus using smaller gas turbines and results in more environmentally friendly emissions.

Comparative study of cholinergic and oxidative stress biomarkers in brains of diabetic and hypercholesterolemic rats.

OBJECTIVE: Diabetes mellitus (DM) and hypercholesterolemia (HC) when poorly controlled lead to debilitating central nervous system complications including cognitive deficits and memory impairment. In the present study, we investigated the mechanisms that may be responsible for such deficits. METHODS: Both diabetes and HC were induced in two groups of rats independently using alloxan and high cholesterol diet, respectively. RESULTS: Acetyl cholinesterase was significantly increased in brain of diabetic rats. Also, brain malondialdehyde level was extremely elevated in both diabetic and hypercholesterolemic groups. Meanwhile, brain albumin was markedly decreased in both of them. However, the brain iron level was significantly increased in DM with concomitant increase in total antioxidant capacity in the same group as compared to the normal control. The concentration of brain calcium was noticeably increased in HC group. Our results were confirmed by the increased activity of lactate dehydrogenase in both DM and HC groups, indicating major brain cytotoxicity. CONCLUSIONS: Overall, our results suggested that both DM and HC have deleterious effects on the brain which may be attributed to oxidative stress and dysregulation of both cholinergic function and calcium level. Administration of antioxidant is recommended in both cases.

CD11c(+) monocyte/macrophages promote chronic Helicobacter hepaticus-induced intestinal inflammation through the production of IL-23.

In inflammatory bowel diseases, a breakdown in host microbial interactions accompanies sustained activation of immune cells in the gut. Functional studies suggest a key role for interleukin-23 (IL-23) in orchestrating intestinal inflammation. IL-23 can be produced by various mononuclear phagocytes (MNPs) following acute microbial stimulation, but little is known about the key cellular sources of IL-23 that drive chronic intestinal inflammation. Here we have addressed this question using a physiological model of bacteria-driven colitis. By combining conditional gene ablation and gene expression profiling, we found that IL-23 production by CD11c(+) MNPs was essential to trigger intestinal immunopathology and identified MHCII(+) monocytes and macrophages as the major source of IL-23. Expression of IL-23 by monocytes was acquired during their differentiation in the intestine and correlated with the expression of major histocompatibility complex class II (MHCII) and CD64. In contrast, Batf3-dependent CD103(+) CD11b(-) dendritic cells were dispensable for bacteria-induced colitis in this model. These studies reinforce the pathogenic role of monocytes in dysregulated responses to intestinal bacteria and identify production of IL-23 as a key component of this response. Further understanding of the functional sources of IL-23 in diverse forms of intestinal inflammation may lead to novel therapeutic strategies aimed at interrupting IL-23-driven immune pathology.

Bioaccumulation potential and physiological responses of aquatic macrophytes to Pb pollution.

In view of their potential bioaccumulation of heavy metals, Ceratophyllum demersum and Myriophyllum spicatum was studied under hydroponic cultures enriched by different Pb concentrations (25, 50, 75 mg/l) for 1-7 days. Both species exerted remarkable capabilities to concentrate Pb in their tissues as compared to control. The highest accumulation value of Pb (164.26 mg/g x dw) was recorded in C. demersum and the most of metal (91.72 mg/g dw) accumulated after 1 d. Significant reduction in photosynthetic pigments and appearance of morphological symptoms such as chlorosis and fragmentation of leaves were evident after 7d at 75 mg/l. The activity of POX and APX, carotenoids and proline showed induction at lower concentration and duration followed by decline. Major re-shuffle in protein patterns appeared as a tolerant mechanism, which both species developed under Pb toxicity. Results suggest that both species responded positively to Pb concentration and accumulated high amount of metal. Due to metal accumulation coupled with detoxification potential, both species appear to have potential for use as phytoremediators and the developed responses can be used as reliable biomarkers for Pb water pollution.

Feasibility and outcomes of endovascular embolization of cerebral arteriovenous malformations at a low-volume centre.

BACKGROUND AND PURPOSE: Herein, we report our initial experience with the endovascular management of cerebral arteriovenous malformations (AVMs) using the liquid embolic agent Onyx and n-butyl cyanoacrylate for AVM embolization. METHODS: We reviewed data from 15 patients with brain AVMs, who were observed at our endovascular facility from January 2008 to July 2011. All cases were embolized with Onyx and/or n-butyl cyanoacrylate. There were 8 women and 7 men with a mean age of 27.2 years (range 17-43 years). The clinical presentations included intracerebral haemorrhage (n = 7), seizures (n = 4), headache (n = 2), and focal neurological deficits (n = 2); according to the Spetzler-Martin classification (Spetzler R and Martin N (1986) J NeurosurgV65 446-83), 8 AVMs were grades I-II, 5 were grade III, and 2 were grades IV-V. RESULTS: A total of 31 embolization procedures were performed in 15 patients, and 44 feeding pedicles were embolized, ranging from 1 to 5 per patient, with an average size reduction of 70% (median 75%, range 40-100%). Total obliteration was achieved for 3 AVMs (20%) (2 patients had single feeders and 1 patient had double feeders), and a partial embolization was achieved in 12 patients (80%). The procedure was related to a permanent disabling morbidity in one patient (6.6%), and no mortalities occurred. CONCLUSIONS: The outcome of (AVM) embolization in our centre is comparable to the reported outcome in other larger-volume centres. The feasibility and safety of AVM embolization in our low-volume centre are similar to the outcomes reported at high-volume centre.

Occupational and environmental risk factors for idiopathic pulmonary fibrosis in Egypt: a multicenter case-control study.

BACKGROUND: Despite the advances in medical therapy and technology, the prognosis of idiopathic pulmonary fibrosis (IPF) remains poor and the need for disease prevention based on identifying the risk factors becomes mandatory. Occupational and environmental exposures were studied in several countries and found to play important role in the disease development. However, in Egypt, a little attention has been paid to study the effect of these factors in the disease development. OBJECTIVE: To identify the occupational and environmental risk factors associated with the development of IPF in Egypt. METHODS: A multicenter hospital-based case-control study was carried out in chest hospitals affiliated to three Egyptian cities-Cairo, Tanta and Mansoura. Subjects were 201 patients with confirmed IPF (cases) and 205 age-, sex- and residence-matched controls. Data on occupational and environmental factors were obtained from a questionnaire. Multiple logistic regression analysis was used to determine the independent risk factors of IPF in both sexes for single factors with adjustment for age, residence and smoking status. RESULTS: Compared with the controls, the risk of IPF in male workers was observed to increase significantly in chemical and petrochemical industries and carpentry and wood working (OR = 2.56, 95% CI: 1.02-7.01), and with occupational exposures to wood dust and wood preservatives. Among female workers, a significant increase was observed in farming (OR = 3.34, 95% CI: 1.17-10.12), raising birds and occupational exposures to animal feeds, products and dusts and pesticides. Risk of IPF decreased significantly in male workers and insignificantly among female workers in sales and clerical related activities. The environmental exposures to birds and cats were significantly associated with elevated risk of IPF development in both sexes. CONCLUSION: In Egypt, farming, raising birds and wood working are important risk factors for the development of IPF.

Sildenafil for erectile dysfunction in the Middle East: observational analysis of patients with diabetes and/or hypertension treated in the clinical practice setting.

The effectiveness and tolerability of 12 weeks of open-label treatment with sildenafil citrate for erectile dysfunction (ED) associated with a diagnosis of diabetes mellitus and/or hypertension were assessed in clinical practice in three Middle Eastern countries. The dose was initially 50 mg and was adjusted by the physician as needed (permissible dose range 25 - 100 mg). Total mean ± SD score on the five-item version of the International Index of Erectile Function (severe ED, score 0 - 7; no ED, score 22 - 25) was 13.6 ± 5.7 at baseline (4556 patients) and increased significantly to 21.7 ± 4.1 at week 12. Global effectiveness was rated as good or very good by 91.4% of patients, 93.9% rating their sexual activity as spontaneous and 91.4% as natural. Discontinuation of sildenafil due to adverse events was infrequent (0.5%). Tolerability was rated as good or very good by 95.7% of patients. It is concluded that sildenafil was a well-tolerated and highly effective treatment of ED in outpatients with diabetes and/or hypertension from the three Middle Eastern countries studied.

Accumulation and soil-to-plant transfer of radionuclides in the Nile Delta coastal black sand habitats.

The radionuclide content was estimated in the soil of three black sand habitats in the Mediterranean coast of Egypt, namely, sand mounds and coastal sand planes and dunes. In addition, a total of 14 heavy minerals found in the soils were characterized. The soil to plant transfer of uranium and thorium was tested on three black sand species, namely, Cakile maritima Scop., Senecio glaucus L. and Rumex Pictus Forssk. The transfer of thorium and uranium radionuclides from the soil to plant is complex process that is subjected to many variables; among which are the organic matter and clay content of the soil, the type of radionuclides and plant species. The study revealed a strong negative relationship between uranium and thorium uptake by S. glaucus and R. pictus and the clay and organic matter content of soil. Concentration of thorium in the soil has a negative correlation with soil-to-plant transfer factor. The study results suggest the possibility of using black sand species for phytoremediation of soils contaminated with radioactive elements. The potentiality of S. glaucus as phytoremediator of radionuclides polluted soils is greater than R. pictus which in turn outweigh C. maritima.