Persistent Shortness of Breath in Post-COVID-19 Patients: Inducible Laryngeal Obstruction Can Be a Cause.

BACKGROUND: Inducible laryngeal obstruction (ILO) is the adduction of the true vocal folds during inspiration or, less frequently, expiration. Its etiology is unknown. PURPOSE: This study aimed to identify ILO as a possible cause of shortness of breath (SOB) in post-COVID-19 patients. METHODS: A retrospective study was conducted on 59 post-COVID-19 adults complaining of SOB. We collected the cases' clinical and chest imaging data, including demographic data, pulmonary function test (PFT), CT chest, and laryngeal endoscopic examination. A visual score was used to assign the severity of the glottic obstruction. The grades of this score ranged from 0 (complete patency) to 3 (almost complete closure). RESULTS: ILO was detected in 8 out of 59 cases (13.5%). Two cases out of eight had glottic closure grade 1, while five cases had glottic closure grade 2, and one had glottic closure grade 3. There was a positive correlation between ILO grades (the severity of glottic closure) and PFT results (the degree of upper airway restriction). PFTs in ILO have a specific pattern. It was typical for the expiratory loop to be normal and the inspiratory loop to be flattened. CONCLUSION: ILO is a possible cause of SOB in post-COVID-19 adult cases. It should be considered during evaluation and management.

Translation and Validation of an Arabic Version of the Voice Disability Coping Questionnaire.

OBJECTIVES/HYPOTHESES: Voice disorders can significantly affect the quality of life. This study aimed to translate, culturally adapt, and validate an Arabic version of the voice disability coping questionnaire (A-VDCQ) for use in Arabic-speaking populations with dysphonia. STUDY DESIGN: This was a cross-sectional study involving the translation and cultural adaptation of the VDCQ into Arabic. The validation process included reliability and validity assessments. Participants were categorized into cases (individuals with dysphonia) and controls (individuals without dysphonia) to compare coping strategies between the two groups. METHODS: ccccccccThe 15-item VDCQ was translated from English into Arabic using the forward and backward translation methods. The questionnaire's reliability was assessed using Cronbach's alpha and test-retest reliability (intraclass correlation coefficient, ICC). Validity was evaluated by comparing cases and controls using the Mann-Whitney test. Differences in coping strategies across different diagnoses were examined using the Kruskal-Wallis test. RESULTS: The A-VDCQ demonstrated satisfactory internal consistency (Cronbach's alpha = 0.769) and excellent test-retest reliability (ICC = 0.993). Significant differences in coping strategies between the cases and controls were also observed (P < 0.001), supporting the instrument's validity. Notably, item 4, which is related to information seeking, had the highest impact score among the cases. However, no statistically significant differences were found in coping strategies across different diagnoses (P = 0.249). CONCLUSIONS: The A-VDCQ demonstrated robust psychometric properties for assessing coping strategies in individuals with voice disorders and such strategies' potential implications for clinical practice and research.

Validity and Reliability of the Arabic Version of the Glottal Function Index in Dysphonic Patients.

OBJECTIVES/HYPOTHESIS: The Glottal Function Index (GFI) is a four-item self-administered survey suitable for the evaluation and treatment of patients with glottal dysfunction. To date, it has been translated into Lithuanian, Persian, and Hebrew. This study is intended to translate and cross-culturally adapt the GFI for use in Arabic-speaking patients with dysphonia. STUDY DESIGN: This work is a cross-sectional study involving the administration of the GFI to participants with dysphonia (cases) and patients without dysphonia (controls). The validation process included reliability and validity assessments. METHODS: The GFI was translated using forward and backward translation methods from English into Arabic. The questionnaire's reliability was assessed using Cronbach's alpha and test-retest reliability (intraclass correlation coefficient, ICC). The Mann-Whitney test evaluated validity by comparing cases and controls. Finally, the Kruskal-Wallis test examined differences in the GFI across various pathologies. RESULTS: The GFI demonstrated favorable internal consistency (Cronbach's alpha = 0.848) and excellent test-retest reliability (ICC = 0.993). Significant differences in the A-GFI score between the cases and controls were also observed (P < 0.001), supporting the instrument's validity. However, no statistically significant differences were found in A-GFI across different diagnoses (P = 0.712). CONCLUSIONS: The A-GFI is a valid and reliable screening tool for clinicians to assess dysphonia and voice impairment in patients in Arabic-speaking countries. The tool is easy to administer in daily clinical practice given its brevity and self-administration.

Validity and Reliability of the Arabic Thyroidectomy-Related Voice and Symptom Questionnaire (A-TVSQ) for Assessing Post-Thyroidectomy Patients.

OBJECTIVE: Post-thyroidectomy patients commonly experience voice changes, swallowing symptoms, and neck discomfort, a condition known as post-thyroidectomy syndrome. The Thyroidectomy-Related Voice and Symptom Questionnaire (TVSQ) is a validated tool showing strong correlations with established tools with a potential predictive value for post-thyroidectomy voice outcomes. Our study aims to translate and validate the TVSQ into Arabic. METHODS: This validation study was conducted at King Abdulaziz University Hospital and King Khalid University Hospital in Riyadh, Saudi Arabia. Forward and backward translations ensured the conceptual equivalence of the Arabic TVSQ (A-TVSQ) and were reviewed by an expert panel. A pilot test assessed the A-TVSQ's face validity and clarity, leading to necessary cultural adjustments. The final A-TVSQ was preoperatively and postoperatively administered to thyroidectomy patients to evaluate its test-retest reliability. RESULTS: Data were collected from 116 participants (53 cases [45.6%] and 63 controls [54.3%]). The internal consistency analysis showed strong intercorrelation among the A-TVSQ items, with Cronbach's alpha coefficients (0.951) indicating excellent estimated internal consistency within both domains. Test-retest reliability showed a moderate level of reliability with an intraclass correlation coefficient of 0.696. A-TVSQ item discrimination analysis showed significant associations between the total and domain scores pre- and post-thyroidectomy. External validity analysis showed significant changes in A-TVSQ voice change (P < 0.010) and neck discomfort (P = 0.011) domains and total scores (P < 0.010) between before and 2 weeks after thyroidectomy. However, no significant changes were observed between 2 and 4 weeks after thyroidectomy. CONCLUSIONS: The translated and validated A-TVSQ showed excellent internal consistency and moderate test-retest reliability, comparable to the original version. Voice change significantly worsened after thyroidectomy, highlighting the need for continued monitoring and management strategies for this complication.

Biogenic Silver Nanoparticles Produced by Soil Rare Actinomycetes and Their Significant Effect on Aspergillus-derived mycotoxins.

The current investigation addressed the green synthesis of silver nanoparticles (AgNPs) using newly isolated silver-resistant rare actinomycetes, Glutamicibacter nicotianae SNPRA1 and Leucobacter aridicollis SNPRA2, and investigated their impact on the mycotoxigenic fungi Aspergillus flavus ATCC 11498 and Aspergillus ochraceus ATCC 60532. The formation of AgNPs was evidenced by the reaction's color change to brownish and the appearance of the characteristic surface plasmon resonance. The transmission electron microscopy of biogenic AgNPs produced by G. nicotianae SNPRA1 and L. aridicollis SNPRA2 (designated Gn-AgNPs and La-AgNPs, respectively) revealed the generation of monodispersed spherical nanoparticles with average sizes of 8.48 ± 1.72 nm and 9.67 ± 2.64 nm, respectively. Furthermore, the XRD patterns reflected their crystallinity and the FTIR spectra demonstrated the presence of proteins as capping agents. Both bioinspired AgNPs exhibited a remarkable inhibitory effect on the conidial germination of the investigated mycotoxigenic fungi. The bioinspired AgNPs caused an increase in DNA and protein leakage, suggesting the disruption of membrane permeability and integrity. Interestingly, the biogenic AgNPs completely inhibited the production of total aflatoxins and ochratoxin A at concentrations less than 8 µg/mL. At the same time, cytotoxicity investigations revealed the low toxicity of the biogenic AgNPs against the human skin fibroblast (HSF) cell line. Both biogenic AgNPs exhibited feasible biocompatibility with HSF cells at concentrations up to 10 µg/mL and their IC50 values were 31.78 and 25.83 µg/mL for Gn-AgNPs and La-AgNPs, respectively. The present work sheds light on the antifungal prospect of the biogenic AgNPs produced by rare actinomycetes against mycotoxigenic fungi as promising candidates to combat mycotoxin formation in food chains at nontoxic doses.

Biosynthesis of Novel Tellurium Nanorods by Gayadomonas sp. TNPM15 Isolated from Mangrove Sediments and Assessment of Their Impact on Spore Germination and Ultrastructure of Phytopathogenic Fungi.

The biosynthesis of nanoparticles using green technology is emerging as a cost-efficient, eco-friendly and risk-free strategy in nanotechnology. Recently, tellurium nanoparticles (TeNPs) have attracted growing attention due to their unique properties in biomedicine, electronics, and other industrial applications. The current investigation addresses the green synthesis of TeNPs using a newly isolated mangrove-associated bacterium, Gayadomonas sp. TNPM15, and their impact on the phytopathogenic fungi Fusarium oxysporum and Alternaria alternata. The biogenic TeNPs were characterized using transmission electron microscopy (TEM), scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), X-ray diffraction (XRD), Raman spectroscopy and Fourier transform infrared (FTIR). The results of TEM revealed the intracellular biosynthesis of rod-shaped nanostructures with a diameter range from 15 to 23 nm and different lengths reaching up to 243 nm. Furthermore, the successful formation of tellurium nanorods was verified by SEM-EDX, and the XRD pattern revealed their crystallinity. In addition, the FTIR spectrum provided evidence for the presence of proteinaceous capping agents. The bioinspired TeNPs exhibited obvious inhibitory effect on the spores of both investigated phytopathogens accomplished with prominent ultrastructure alternations, as evidenced by TEM observations. The biogenic TeNPs impeded spore germination of F. oxysporum and A. alternata completely at 48.1 and 27.6 µg/mL, respectively. Furthermore, an increase in DNA and protein leakage was observed upon exposure of fungal spores to the biogenic TeNPs, indicating the disruption of membrane permeability and integrity. Besides their potent influence on fungal spores, the biogenic TeNPs demonstrated remarkable inhibitory effects on the production of various plant cell wall-degrading enzymes. Moreover, the cytotoxicity investigations revealed the biocompatibility of the as-prepared biogenic TeNPs and their low toxicity against the human skin fibroblast (HSF) cell line. The biogenic TeNPs showed no significant cytotoxic effect towards HSF cells at concentrations up to 80 µg/mL, with a half-maximal inhibitory concentration (IC50) value of 125 µg/mL. The present work spotlights the antifungal potential of the biogenic TeNPs produced by marine bacterium against phytopathogenic fungi as a promising candidate to combat fungal infections.

Prognostic value of free air under diaphragm on chest radiographs in correlation with peritoneal soiling intraoperatively.

PURPOSE: Gastrointestinal perforation is a significant injury that originates mainly from gastrointestinal ulcers. It is associated with a high rate of morbidity and mortality. The height of the column of the air under the diaphragm can be used to estimate the amount of peritoneal soiling due to viscus perforation. This study aimed to determine the correlation between this estimate and the incidence of morbidity and mortality. METHODS: To achieve this aim, a prospective cohort study was conducted on 83 patients at Kasr al ainy hospital who, between March 2021 and March 2022, presented to the emergency department with free air under the diaphragm at chest X-ray and required surgical intervention for a perforated viscus. For each case, the amount of peritoneal soiling and the amount of air under the diaphragm as determined by a chest X-ray were recorded. RESULTS: The mean air under the diaphragm in a plain erect chest X-ray was 1.78 ± 1.92 cm, and the mean amount of peritoneal soiling was 1201.83 ± 948.99 CC. There are positive correlations between the amount of air under the diaphragm as shown on an X-ray and the size of the perforation (p = 0.034), the amount of peritoneal soiling (p = 0.003), and the mortality (p = 0.013). CONCLUSION: There was a statistically significant correlation between air under the diaphragm according to X-ray and the amount of peritoneal soiling in patients with a perforated viscus. This measure can be used as a sensitive tool to predict morbidity and mortality as more free air in the chest X-ray is associated with significant mortality. These results may enhance the decision making using sensitive and available tool of diagnosis.

Position Statement of the Union of European Phoniatricians (UEP): Fees and Phoniatricians' Role in Multidisciplinary and Multiprofessional Dysphagia Management Team.

The need for multidisciplinary and multiprofessional management of dysphagia is constantly increasing and creating a major challenge for healthcare professionals and society, especially in terms of professional expertise and human resources. The distribution of tasks among the dysphagia team members, which includes phoniatricians, otolaryngologists, and speech-language therapists, is flexible and overlapping. For assessing dysphagia, the (fibreoptic) flexible endoscopic evaluation of swallowing (FEES), with or without videofluoroscopy, is a pivotal diagnostic tool. This position paper aims to illustrate the phoniatrician's role in performing a FEES, which is an indispensable component of the diagnostic workup of patients suffering from oropharyngeal dysphagia. It is based on the current collaborative expert view of the Swallowing Committee of the Union of European Phoniatricians and a literature review. A FEES is one of the core competences of phoniatricians due to their endoscopic expertise and experience in the field of dysphagia and diseases of the upper aerodigestive tract. Therefore, the phoniatrician is an important member of the dysphagia team, for the medical diagnostics of the aerodigestive tract and dysphagia as well as for FEES. Phoniatric competence is especially important for head and neck cancer patients, infants, and complex cases.

Self-perceived dysphagia in non-invasively ventilated COVID-19 patients.

PURPOSE: COVID-19 is known to present with a wide range of clinical symptoms. COVID-19-related dysphagia has been frequently investigated in patients who were critically ill and mechanically ventilated, but not in those with less severe presentations. This study aims to identify the frequency, characteristics, and severity of self-perceived oropharyngeal dysphagia in non-intubated COVID-19 patients. METHODS: In this cross-sectional study, data were collected from patients using a self-administered questionnaire that included the Eating Assessment Tool (EAT-10). RESULTS: The study included 359 participants with a median age of 34 (range: 18-65) years. Self-perceived dysphagia (EAT-10 total score > 2) was identified in 64.62%, and their median EAT-10 total score was 13 (range 3-40). The most prevalent symptoms were painful swallowing, affected pleasure of eating, stressful swallowing, and coughing while eating. Age, gender, and hospitalization were not statistically significantly associated with the presence of dysphagia, while re-infection, duration, and severity of COVID-19 diagnosis were. The EAT-10 total score was higher in moderate and severe COVID-19 cases as compared to mild cases, and showed a statistically significant inverse correlation with the duration of COVID-19 (r = - 0.267). CONCLUSION: Self-perceived dysphagia was prevalent in non-intubated COVID-19 patients. Its severity was related to that of COVID-19 and its duration.

Novel Torque and Drag Model for Drilling Two-Dimensional High-Angle Wells.

Planning high-angle wells involves diverse areas; one of the most important of these areas is torque and drag (T&D) management. Not only could uncontrolled T&D cause various drilling problems like drill string (D/S) failures, casing wear, stuck pipes, and slow rates of penetration but it could also entirely stop the drilling progress, if torque and/or drag exceed rig or string capabilities. Modeling T&D in advance would alleviate these problems by prediction of friction forces to be encountered and urging the drilling team to take the required measures to mitigate these forces or upgrade the drilling hardware (rig equipment and/or D/S). Modeling T&D is still a complex and time-consuming job to be carried out at the rig site while drilling, so that an accurate and rig-friendly model would be very useful to industry. In this work, a novel and simple model had been developed to predict T&D values while drilling both curve and tangent sections of high-angle wells based on a soft-string concept, in which the D/S is assumed to be a chain lying on the lower side of the well that can transmit torsional forces. Despite the simplicity of the calculations, the model accounts for components of drilling torque that are overlooked in most complex packages. Friction within the top drive system had been considered to predict the torque acting on the D/S only. In addition, the torque applied on the D/S by the viscous drilling fluid was accounted for by reversing the concept of viscometers. The model proved to be practical and reliable for the two-dimensional wellbore and thus is superior in terms of quick field application. The developed model was tested using data from the Western Desert, Egypt. Statistical analysis had been used to assure the accuracy of the proposed model and to assess the effect of different drilling parameters and practices on both T&D. The reliability of the model had been proven with a negligible error for drag calculations and 10% error on average for torque calculations. Also, the effect of distance between successive survey stations on T&D modeling had been proven mathematically. This research narrows the gap between theory and practice by studying the dominant factors and determining the extent of the effect of each of them on wellbore friction forces. In addition, the work sheds light on the best practices concluded from the application of the developed model on field data.

Impact of photodynamic therapy as an adjunct to non-surgical periodontal treatment on clinical and biochemical parameters among patients having mild rheumatoid arthritis with periodontitis.

PURPOSE: To evaluate the efficacy of photodynamic therapy (PDT) as an adjunct to non-surgical periodontal therapy on the clinical periodontal and biochemical parameters among patients with rheumatoid arthritis (RA) having periodontitis. METHODS: A total of 50 RA patients with periodontitis were included. The subjects were equally divided into two groups: Group A - scaling and root planning (SRP) + PDT; Group B - SRP only, respectively. Plaque score (PS), bleeding on probing (BOP), and pocket depth (PD) were estimated. The biochemical parameters included the assessment of interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-α) and rheumatoid factors (RFs). RESULTS: Plaque scores and BOP significantly reduced in both the groups at both 6 and 12 weeks with significant difference between both the groups at 6 weeks follow up (p<0.05). On inter-group comparison, there was a statistically significant reduction seen for BOP in Group A at 12 weeks (p<0.001). PD significantly reduced in both the groups at both time points; however, significant reduction was noted for Group A compared to Group B (p<0.01). IL-6 and TNF-α significantly reduced in both the groups at 6 and 12 weeks follow up. However, the proinflammatory cytokine levels significantly reduced in group A as compared to group B at both 6 and 12 weeks (p<0.05). GCF levels of RF did not show any change in either of the groups at either time point or between the groups (p>0.05). CONCLUSION: PDT significantly reduced the proinflammatory burden in terms of periodontal attachment level and bleeding on probing within the periodontal inflammatory pockets in patients having RA.

An Overview on Synthetic 2-Aminothiazole-Based Compounds Associated with Four Biological Activities.

Amongst sulfur- and nitrogen-containing heterocyclic compounds, the 2-aminothiazole scaffold is one of the characteristic structures in drug development as this essential revelation has several biological activities abiding it to act as an anticancer, antioxidant, antimicrobial and anti-inflammatory agent, among other things. Additionally, various 2-aminothiazole-based derivatives as medical drugs have been broadly used to remedy different kinds of diseases with high therapeutic influence, which has led to their wide innovations. Owing to their wide scale of biological activities, their structural variations have produced attention amongst medicinal chemists. The present review highlights the recently synthesized 2-aminothiazole-containing compounds in the last thirteen years (2008-2020). The originality of this proposal is based on the synthetic strategies developed to access the novel 2-aminothiazole derivatives (N-substituted, 3-substituted, 4-substituted, multi-substituted, aryl/alkyl substituents or acyl/other substituents). The literature reports many synthetic pathways of these 2-aminothiazoles associated with four different biological activities (anticancer, antioxidant, antimicrobial and anti-inflammatory activities). It is wished that this review will be accommodating for new views in the expedition for rationalistic designs of 2-aminothiazole-based medical synthetic pathways.

Bioactive Levan-Type Exopolysaccharide Produced by Pantoea agglomerans ZMR7: Characterization and Optimization for Enhanced Production.

Levan is an industrially important, functional biopolymer with considerable applications in the food and pharmaceutical fields owing to its safety and biocompatibility. Here, levan-type exopolysaccharide produced by Pantoea agglomerans ZMR7 was purified by cold ethanol precipitation and characterized using TLC, FTIR, 1H, and 13C NMR spectroscopy. The maximum production of levan (28.4 g/l) was achieved when sucrose and ammonium chloride were used as carbon and nitrogen sources, respectively, at 35°C and an initial pH of 8.0. Some biomedical applications of levan like antitumor, antiparasitic, and antioxidant activities were investigated in vitro. The results revealed the ability of levan at different concentrations to decrease the viability of rhabdomyosarcoma and breast cancer cells compared with untreated cancer cells. Levan appeared also to have high antiparasitic activity against the promastigote of Leishmania tropica. Furthermore, levan had strong DPPH radical scavenging (antioxidant) activity. These findings suggest that levan produced by P. agglomerans ZMR7 can serve as a natural biopolymer candidate for the pharmaceutical and medical fields.

Facial skin cancer reconstructive and cosmetic outcomes: Analysis with algorithm for its management.

BACKGROUND: Management of facial skin cancer and its complications is important research topics needing continuous update to improve the outcome. OBJECTIVE: The study is to share our findings with surgeons and healthcare providers. The authors provide their efforts by pooling data from multiple institutions; as reporting surgical outcomes is significantly lacking and much needed in the Middle East and North Africa region in order to meaningfully improve quality of care. This study proposes an algorithm for management that could aid a surgical decision-making for reconstruction of defects after excision of facial skin cancer. METHODS: Retrograde simple descriptive analysis study is conducted for multicenter data about management of facial skin cancer and its cosmetic outcome. The analysis involves 159 male patients and 95 females. RESULTS: Nonmelanoma skin cancer was reported in 250 (98.4%) of 254 cases. Reconstructive procedures were complicated in 16 cases (~6.3% of the study). Skin cancer recurrence in head and neck has happened in five cases (~1.9% of the study). Flaps used survived without major complications; however, V-Y advancement flaps showed the best aesthetic outcome. CONCLUSION: This study reports data in order to meaningfully improve the quality of care. Disease incidence, reconstructive complications, recurrences, and aesthetic outcome of facial skin cancer are included in the study. Based on the data pooling, the study proposes a simple treatment algorithm that could aid in surgical decision-making. V-Y advancement flaps showed the best aesthetic outcome.

Molecular cloning, structural modeling and characterization of a novel glutaminase-free L-asparaginase from Cobetia amphilecti AMI6.

The exploration of new sources of L-asparaginase with low glutaminase activity is of great interest in both medical and food applications. In the current study, a novel L-asparaginase gene (CobAsnase) from halotolerant Cobetia amphilecti AMI6 was cloned and over-expressed in Escherichia coli. The enzyme had a molecular mass of 37 kDa on SDS-PAGE and dynamic light scattering (DLS) analysis revealed that CobAsnase is a homotetramer in solution. The purified enzyme showed optimum activity at pH and temperature of 7 and 60 °C, respectively, with obvious thermal stability. It exhibited strict substrate specificity towards L-asparagine with no detectable activity on L-glutamine. Pre-treatment of potato slices by CobAsnase prior to frying reduced the acrylamide contents in the processed chips up to 81% compared with untreated control. These results suggest that CobAsnase is a potential candidate for applications in the food industry for mitigation of acrylamide formation in fried potato and baked foods.

Effect of high-dose Omega 3 on lipid profile and inflammatory markers in chronic hemodialysis children.

Atherosclerosis, cardiovascular diseases (CVDs), and inflammation are important problems in chronic kidney disease (CKD) patients on chronic hemodialysis (HD). Prevention of CKD patients of CVD can lower the mortality rate in them. Omega 3 may help in the treatment of inflammation and lipid abnormalities in end-stage renal disease (ESRD) patients on chronic HD. This study aimed to evaluate the effect of high-dose Omega 3 on lipid profile and inflammatory markers in ESRD children on chronic HD. This clinical trial was conducted on 49 ESRD children on chronic HD selected from pediatric HD unit of Menoufia University Hospital. The study was conducted for a period of three months. The selected children were supplemented with 2000-mg Omega 3 tablets daily; lipid profile and inflammatory markers were assessed at the beginning and at the end of the study. Supplementation with high-dose Omega 3 resulted in a highly statistically significant decrease in total cholesterol, triglyceride, low-density lipoprotein, interleukin-6, C- reactive protein levels and a highly statistically significant increase in high-density lipoprotein (P <0.001). The differences between hemoglobin, platelets, iron profile, parathyroid hormone, albumin, phosphorus, calcium, potassium, sodium, and efficiency of dialysis before and after Omega 3 supplementation were not statistically significant (P >0.05). Supplementation with highdose Omega 3 caused significant improvement in lipid profile and inflammatory markers of children on chronic HD.

Colonization of intestinal microbiota with carbapenemase-producing Enterobacteriaceae in paediatric intensive care units in Cairo, Egypt.

BACKGROUND AND STUDY AIMS: Colonized patients with carbapenamase producing Enterobacteriaceae (CPE) are vulnerable to invasive infections from their endogenous flora. We aimed to assess faecal colonization with (CPE) among children admitted to Cairo University paediatric intensive care units (ICUs). The phenotypic and genotypic characterizations of carbapenemase-producing Enterobacteriaceae were also studied. PATIENTS AND METHODS: A total of 413 Enterobacteriaceae isolates have been isolated from cultured rectal swabs of 100 children. All swabs were inoculated on ChromID™ CARBA agar to screen for carbapenem resistant Enterobacteriaceae (CRE). Disk diffusion method, Modified Hodge test (MHT) and further genotypic detection of carbapenemases genes (blaOXA-48, blaKPC and blaNDM-1, blaVIM and blaIMP) by multiplex PCR were done. RESULTS: Out of 413 Enterobacteriaceae isolates; 100 isolates were defined as CRE. BlaOXA-48 was detected in (33%); Escherichia coli (n = 11), Klebsiella oxytoca (n = 3) and Klebsiella pneumoniae (n = 19), while (27%) carried blaNDM-1Escherichia coli (n = 7), and Klebsiella pneumoniae (n = 20). CONCLUSION: Prevalence of carbapenem resistant Enterobacteriaceae was 24%, various genes of carbapenemases were detected in 80% of carbapenem resistant Enterobacteriaceae with dominance of blaOXA-48. Understanding the colonization status of our patients with strict infection control measures can reduce the risk of horizontal gene transfer of carbapenemases.

Development of the Arabic Voice Pathology Database and Its Evaluation by Using Speech Features and Machine Learning Algorithms.

A voice disorder database is an essential element in doing research on automatic voice disorder detection and classification. Ethnicity affects the voice characteristics of a person, and so it is necessary to develop a database by collecting the voice samples of the targeted ethnic group. This will enhance the chances of arriving at a global solution for the accurate and reliable diagnosis of voice disorders by understanding the characteristics of a local group. Motivated by such idea, an Arabic voice pathology database (AVPD) is designed and developed in this study by recording three vowels, running speech, and isolated words. For each recorded samples, the perceptual severity is also provided which is a unique aspect of the AVPD. During the development of the AVPD, the shortcomings of different voice disorder databases were identified so that they could be avoided in the AVPD. In addition, the AVPD is evaluated by using six different types of speech features and four types of machine learning algorithms. The results of detection and classification of voice disorders obtained with the sustained vowel and the running speech are also compared with the results of an English-language disorder database, the Massachusetts Eye and Ear Infirmary (MEEI) database.

Application of in-plant control measures in some Egyptian micro-scale dairy enterprises and its impact on heavy metal contents of their products.

Egypt is encouraging micro-scale enterprises as proved to be one of the most important reasons of economic growth. Most of the annual milk production is processed in micro-scale dairy enterprises located in squatter areas with high health risks and negative environmental impact. The aim of this study was to assess the effectiveness of in-plant control measures in controlling lead and cadmium levels in dairy products from nine Egyptian micro-scale enterprises. The results revealed that white cheese enterprises had the highest mean lead and cadmium contents; both in their raw milk (0.712 and 0.134 mg/L, respectively) and final products (0.419 and 0.061 mg/kg). Higher compliance percentages were found with cadmium levels specified in the Egyptian standards than with lead levels and ranged from 59.4% in raw milk to 100% in dry milk for cadmium levels and from 8.3% in white cheese to 66.7% in ice cream for lead; moreover, none of the collected raw milk samples were complying with the lead levels. After implementation of in-plant control measures, lower lead levels were found in all samples with reduction percentages ranging from 35.2% in raw milk from the ice cream enterprises to 73.2% in yoghurt; moreover, higher percentages of samples complied with cadmium levels. This study highlights the urgent need for applying in-plant control measures to the Egyptian micro-scale dairy enterprises to improve both safety and quality of their products.

An Investigation of Multidimensional Voice Program Parameters in Three Different Databases for Voice Pathology Detection and Classification.

BACKGROUND AND OBJECTIVE: Automatic voice-pathology detection and classification systems may help clinicians to detect the existence of any voice pathologies and the type of pathology from which patients suffer in the early stages. The main aim of this paper is to investigate Multidimensional Voice Program (MDVP) parameters to automatically detect and classify the voice pathologies in multiple databases, and then to find out which parameters performed well in these two processes. MATERIALS AND METHODS: Samples of the sustained vowel /a/ of normal and pathological voices were extracted from three different databases, which have three voice pathologies in common. The selected databases in this study represent three distinct languages: (1) the Arabic voice pathology database; (2) the Massachusetts Eye and Ear Infirmary database (English database); and (3) the Saarbruecken Voice Database (German database). A computerized speech lab program was used to extract MDVP parameters as features, and an acoustical analysis was performed. The Fisher discrimination ratio was applied to rank the parameters. A t test was performed to highlight any significant differences in the means of the normal and pathological samples. RESULTS: The experimental results demonstrate a clear difference in the performance of the MDVP parameters using these databases. The highly ranked parameters also differed from one database to another. The best accuracies were obtained by using the three highest ranked MDVP parameters arranged according to the Fisher discrimination ratio: these accuracies were 99.68%, 88.21%, and 72.53% for the Saarbruecken Voice Database, the Massachusetts Eye and Ear Infirmary database, and the Arabic voice pathology database, respectively.