Breaking the silence: empowering the mute-deaf community through automatic sign language decoding.

OBJECTIVES: The objective of this study is to develop a system for automatic sign language recognition to improve the quality of life for the mute-deaf community in Egypt. The system aims to bridge the communication gap by identifying and converting right-hand gestures into audible sounds or displayed text. METHODS: To achieve the objectives, a convolutional neural network (CNN) model is employed. The model is trained to recognize right-hand gestures captured by an affordable web camera. A dataset was created with the help of six volunteers for training, testing, and validation purposes. RESULTS: The proposed system achieved an impressive average accuracy of 99.65 % in recognizing right-hand gestures, with high precision value of 95.11 %. The system effectively addressed the issue of gesture similarity between certain alphabets by successfully distinguishing between their respective gestures. CONCLUSIONS: The proposed system offers a promising solution for automatic sign language recognition, benefiting the mute-deaf community in Egypt. By accurately identifying and converting right-hand gestures, the system facilitates communication and interaction with the wider world. This technology has the potential to greatly enhance the quality of life for individuals who are unable to speak or hear, promoting inclusivity and accessibility.

An Analysis of Positron Emission Tomography Maximum Standard Uptake Value Among Patients With Head and Neck Cancer Receiving Photon and Proton Radiation.

PURPOSE: One main advantage of proton therapy versus photon therapy is its precise radiation delivery to targets without exit dose, resulting in lower dose to surrounding healthy tissues. This is critical, given the proximity of head and neck tumors to normal structures. However, proton planning requires careful consideration of factors, including air-tissue interface, anatomic uncertainties, surgical artifacts, weight fluctuations, rapid tumor response, and daily variations in setup and anatomy, as these heterogeneities can lead to inaccuracies in targeting and creating unwarranted hotspots to a greater extent than photon radiation. In addition, the elevated relative biological effectiveness at the Bragg peak's distal end can also increase hot spots within and outside the target area. METHODS AND MATERIALS: The purpose of this study was to evaluate for a difference in positron emission tomography (PET) standard uptake value (SUV) after definitive treatment, between intensity modulated proton therapy (IMPT) and intensity modulated photon therapy (IMRT). In addition, we compared the biologic dose between PET areas of high and low uptake within the clinical target volume-primary of patients treated with IMPT. This work is assuming that the greater SUV may potentially result in greater toxicities. For the purposes of this short communication, we are strictly focusing on the SUV and do not have correlation with toxicity outcomes. To accomplish this, we compared the 3- and 6-month posttreatment fluorodeoxyglucose PET scans for 100 matched patients with oropharyngeal cancer treated definitively without surgery using either IMPT (n = 50) or IMRT (n = 50). RESULTS: Our study found a significant difference in biologic dose between the high- and low-uptake regions on 3-month posttreatment scans of IMPT. However, this difference did not translate to a significant difference in PET uptake in the clinical target volume-primary at 3 and 6 months' follow-up between patients who received IMPT versus IMRT. CONCLUSIONS: Studies have proposed that proton's greater relative biological effectiveness at the Bragg peak could lead to tissue inflammation. Our study did not corroborate these findings. This study's conclusion underscores the need for further investigations with ultimate correlation with clinical toxicity outcomes.

Potential production of Ac-225 at Egyptian second research reactor (ETRR-2) through neutron induced transmutation of Ra-226.

A considerable focus has been paid to the production of 225Ac due to its effective therapeutic action in alpha-targeted radiotherapy. Considering the future global clinical demand, it is necessary to increase the production capacity of 225Ac. A feasibility study was conducted to investigate the production of 225Ac through neutron induced transmutation of 226Ra at the Egyptian Second Research Reactor (ETRR-2) using the MCNPX code. The calculations were carried out for 1 g of 226Ra target exposed to the highest neutron flux in the irradiation grid surrounding the reactor core. The 227Ra, 225Ra, 227Ac, and 225Ac generated activities as a function of irradiation and decay times were estimated. Our study revealed that in this non-linear production process, 39.22 MBq of pure 225Ac could be obtained after three days of irradiation, while 148.74 MBq could be obtained after fifteen days of continuous irradiation.

Hybrid Radiant Disinfection: Exploring UVC and UVB Sterilization Impact on the Mechanical Characteristics of PLA Materials.

This study explores the impact of disinfection techniques on the mechanical properties of poly(lactic acid) (PLA), a crucial material in the production of medical implants, tissue engineering, orthopedic devices and drug delivery systems, owing to its biocompatibility and ease of manufacturing. The focus is on evaluating the effectiveness of ultraviolet (UV) type C (254 nm wavelength) and the combined use of type C and B (310 nm wavelength) disinfection methods. Fifteen tensile test specimens (ASTM D638) and fifteen compression test specimens (ASTM D695) were utilized to assess PLA's mechanical properties, including yield strength, ultimate strength, and fracture strength. The investigation involved subjecting the specimens to the specified disinfection methods and evaluating these properties both before and after the disinfection process. In the tensile test, a statistically significant difference (p = 0) in yield displacement was observed among the three groups. Additionally, a notable difference (p = 0.047) in fracture displacement was identified between the untreated group and the UVC and UVB combination group. No discernible impact on yield or fracture forces was noted. In the compression test, there was a significant difference (p = 0.04) in yield displacement and a clear difference (p = 0.05) in fracture force between the untreated group and the UVC and UVB combination group. The hybrid combination of UVC and UVB disinfection techniques did not affect yield force in both tensile and compression tests. However, it demonstrated a clear impact on displacement, suggesting its potential as a promising disinfection technique in the medical field.

Accurate prediction of gaseous isotopes Xe and Kr concentrations from the burnup of nuclear fuel using simple regression algorithm.

Mathematical techniques for modeling and simulating dangerous or complex systems, such as nuclear technology systems, often require high-performance computing to process and analyze available data. In this paper, simple and quick method to support studies and research related to nuclear fuel is presented. This reasonably simple method helps to predict different concentrations of actinides and fission products in nuclear fuels without the need for expensive specialized programs and highly-trained researchers. The great importance of this approach is the speed of predicting the components of nuclear fuel concentrations, which in turn leads to quick decision-making, such as the possibility of operating fuel at higher burnup values, predicting the amount of gases resulting from nuclear fission (which may accumulate and cause problems in nuclear fuel such as volume swells), and other important decisions in nuclear fuel technology. The predicted equations have been generalized for higher values of burnup and compared with comparable results from MCNP codes. The equations deduced in calculating the different concentrations of xenon and krypton isotopes resulting from fission in burnup of nuclear fuel showed very precise results with discrepancies (magnitude of an error between the data points and the corresponding predicted ones) less than 2%. The suggested method offers a great advantage for researchers, which are the use one of any simple or common computational programs available to most researchers and do not need much experience to deal with, such as MATLAB, Excel that are easy to use for regression analyses. In this paper, the advantages of the proposed method are explained along with the limitations of its use.

Complementary and alternative medicine for children with sickle cell disease: A systematic review.

BACKGROUND: Complementary and alternative medicine (CAM) is a popular alternative to opioid and other analgesics in sickle cell disease (SCD). We review the effectiveness, prevalence, and factors associated with CAM use in the pediatric SCD population. METHODS: The review protocol was created based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search was conducted in MEDLINE, Embase, Cochrane Library, PubMed, and Web of Science. RESULTS: Twenty-four studies were examined. The prevalence of CAM use in pediatric patients with SCD ranged from 36 to 84.5%. Common inpatient CAM interventions were yoga, virtual reality, and acupuncture, which decreased pain scale scores. Outpatient CAMs were consisted of cognitive behavioral therapy, massage therapy, and guided-imagery, which increased pain tolerability and decreased pain scale scores. CONCLUSIONS: CAM modalities can decrease pain scale scores. However, the impact of specific CAM modalities on emergency department visits, hospitalizations, and school absences were inconclusive.

Evaluation of Proton Therapy Reirradiation for Patients With Recurrent Head and Neck Squamous Cell Carcinoma.

Importance: Use of proton therapy reirradiation (PT-ReRT) for head and neck cancer is increasing; however, reports are heterogenous and outcomes can be difficult to interpret. Objective: To evaluate outcomes and toxic effects following PT-ReRT in a uniform and consecutive cohort of patients with head and neck squamous cell carcinoma. Design, Setting, and Participants: This retrospective cohort study included patients with recurrent primary head and neck squamous cell carcinoma who were treated with PT-ReRT from January 1, 2013, to December 31, 2020, at a single institution. Patient, clinical, and treatment characteristics were obtained, and multidisciplinary review was performed to record and grade early and late toxic effects. Exposures: Proton therapy reirradiation. Main Outcomes and Measures: Follow-up was defined from the start of PT-ReRT. The Kaplan-Meier method was used for outcomes of interest, including local control (LC), locoregional control, distant metastatic control, progression-free survival, and overall survival (OS). Cox proportional hazards regression modeling was used to assess associations of covariates with OS. Results: A total of 242 patients (median [range] age, 63 [21-96] years; 183 [75.6%] male) were included. Of these patients, 231 (95.9%) had a Karnofsky performance status score of 70 or higher, and 145 (59.9%) had at least a 10-pack-year smoking history. Median (range) follow-up was 12.0 (5.8-26.0) months for all patients and 24.5 (13.8-37.8) months for living patients. A total of 206 patients (85.1%) had recurrent disease vs second primary or residual disease. The median (range) interval between radiation courses was 22 (1-669) months. Median PT-ReRT dose was 70 cobalt gray equivalents (CGE) for the fractionated cohort and 44.4 CGE for the quad shot cohort. For the fractionated cohort, the 1-year LC was 71.8% (95% CI, 62.8%-79.0%) and the 1-year OS was 66.6% (95% CI, 58.1%-73.8%). For the quad shot cohort, the 1-year LC was 61.6% (95% CI, 46.4%-73.6%) and the 1-year OS was 28.5% (95% CI, 19.4%-38.3%). Higher Karnofsky performance status scores (hazard ratio [HR], 0.50; 95% CI, 0.25-0.99; P = .046) and receipt of salvage surgery prior to PT-ReRT (HR, 0.57; 95% CI, 0.39-0.84; P = .005) were associated with improved OS, whereas receipt of quad shot (HR, 1.97; 95% CI, 1.36-2.86; P < .001) was associated with worse OS. There were a total of 73 grade 3 and 6 grade 4 early toxic effects. There were 79 potential grade 3, 4 grade 4, and 5 grade 5 late toxic effects. Conclusions and Relevance: The findings of this cohort study suggest that, compared with previous reports with photon-based reirradiation, patients are living longer with aggressive PT-ReRT; however, surviving patients remain at risk of early and late complications.

Outcomes for Organ Preservation with Chemoradiation Therapy for T4 Larynx and Hypopharynx Cancer.

OBJECTIVE: Limited data is available to guide non-surgical management of Stage T4 larynx and hypopharynx cancer patients who have inoperable disease or refuse surgery. We aim to review the nonoperative management of T4 laryngeal and hypopharyngeal cancer and report the long-term therapeutic and functional outcomes. METHODS: We reviewed the nonoperative management of T4 laryngeal (n = 44) and hypopharyngeal (n = 53) cancer from 1997 to 2015 and performed a univariate analysis (UVA). RESULTS: The 2-/5-year OS rates were 73%/38% for larynx patients and 52%/29% for hypopharynx patients. Locoregional failure (LRF) occurred in 25% and 19% of larynx and hypopharynx patients, respectively. On UVA of the larynx subset, N3 nodal status and non-intensity-modulated radiation therapy were negatively associated with OS; treatment with radiation therapy alone impacted disease-free survival; and age >70 was associated with LRF. On UVA of the hypopharynx subset, only T4b status significantly impacted OS. In the larynx and hypopharynx groups, 68% and 85% received a percutaneous endoscopic gastrostomy (PEG) tube and 32% and 40% received a tracheostomy tube, respectively. At the last follow-up visit, 66% of our larynx cohort had neither tracheostomy or PEG placed and 40% of our hypopharynx cohort had neither. CONCLUSION: We report better than previously noted outcomes among T4 larynx and hypopharynx patients who have unresectable disease or refuse surgery. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:1138-1145, 2023.

Radiant Reinforcement: Enhancing Composite Polymer Magnet Materials Mechanical Properties with UVC Medical Disinfection.

Magnetic polymer composites have recently attracted considerable interest, primarily because of their promising applications, especially in the biomedical industry. The aim of this study is to investigate the impact of ultraviolet C (UVC) irradiation as a disinfection method on the mechanical characteristics of composite polymer magnets. Tensile and compression tests were conducted following the standards set by ASTM D3039 and ASTM D3410, respectively. In addition, energy dispersive spectroscopy (EDS) was used to determine the effect of the disinfection method on the amount of carbon, oxygen, and iron within the surface of the composite polymer magnet material. The UVC's irradiation impact was statistically assessed by a t-test. The results of the tensile tests demonstrated a significant increase in the transition force, measuring 0.41 kN and 0.58 kN before and after UVC exposure, respectively. Similarly, the outcomes of the compression tests showed a notable increase in yield force, registering 4.9 kN and 6 kN before and after UVC treatment. This suggests that the composite magnetic material has gained a higher capacity to withstand compressive loads than tensile loads. Finally, the EDS analysis revealed the carbon mass percentage was 71.69% prior to UVC radiation exposure, with it increasing to 78.56%, following exposure. This suggests that the composite material exhibited improved hardness. These findings highlight that UVC irradiation has a beneficial impact on both the mechanical and chemical properties of the composite magnet material, which support its use as a disinfection method in clinical settings.

Toxicity Profiles and Survival Outcomes Among Patients With Nonmetastatic Oropharyngeal Carcinoma Treated With Intensity-Modulated Proton Therapy vs Intensity-Modulated Radiation Therapy.

Importance: Patients with oropharyngeal carcinoma (OPC) treated with radiotherapy often experience substantial toxic effects, even with modern techniques such as intensity-modulated radiation therapy (IMRT). Intensity-modulated proton therapy (IMPT) has a potential advantage over IMRT due to reduced dose to the surrounding organs at risk; however, data are scarce given the limited availability and use of IMPT. Objective: To compare toxic effects and oncologic outcomes among patients with newly diagnosed nonmetastatic OPC treated with IMPT vs IMRT with or without chemotherapy. Design, Setting, and Participants: This retrospective cohort study included patients aged 18 years or older with newly diagnosed nonmetastatic OPC who received curative-intent radiotherapy with IMPT or IMRT at a single-institution tertiary academic cancer center from January 1, 2018, to December 31, 2021, with follow-up through December 31, 2021. Exposures: IMPT or IMRT with or without chemotherapy. Main Outcomes and Measures: The main outcomes were the incidence of acute and chronic (present after ≥6 months) treatment-related adverse events (AEs) and oncologic outcomes, including locoregional recurrence (LRR), progression-free survival (PFS), and overall survival (OS). Fisher exact tests and χ2 tests were used to evaluate associations between toxic effects and treatment modality (IMPT vs IMRT), and the Kaplan-Meier method was used to compare LRR, PFS, and OS between the 2 groups. Results: The study included 292 patients with OPC (272 [93%] with human papillomavirus [HPV]-p16-positive tumors); 254 (87%) were men, 38 (13%) were women, and the median age was 64 years (IQR, 58-71 years). Fifty-eight patients (20%) were treated with IMPT, and 234 (80%) were treated with IMRT. Median follow-up was 26 months (IQR, 17-36 months). Most patients (283 [97%]) received a dose to the primary tumor of 70 Gy. Fifty-seven of the patients treated with IMPT (98%) and 215 of those treated with IMRT (92%) had HPV-p16-positive disease. There were no significant differences in 3-year OS (97% IMPT vs 91% IMRT; P = .18), PFS (82% IMPT vs 85% IMRT; P = .62), or LRR (5% IMPT vs 4% IMRT; P = .59). The incidence of acute toxic effects was significantly higher for IMRT compared with IMPT for oral pain of grade 2 or greater (42 [72%] IMPT vs 217 [93%] IMRT; P < .001), xerostomia of grade 2 or greater (12 [21%] IMPT vs 68 [29%] IMRT; P < .001), dysgeusia of grade 2 or greater (16 [28%] IMPT vs 134 [57%] IMRT; P < .001), grade 3 dysphagia (4 [7%] IMPT vs 29 [12%] IMRT; P < .001), mucositis of grade 3 or greater (10 [53%] IMPT vs 13 [70%] IMRT; P = .003), nausea of grade 2 or greater (0 [0%] IMPT vs 18 [8%] IMRT; P = .04), and weight loss of grade 2 or greater (22 [37%] IMPT vs 138 [59%] IMRT; P < .001). There were no significant differences in chronic toxic effects of grade 3 or greater, although there was a significant difference for chronic xerostomia of grade 2 or greater (6 IMPT [11%] vs 22 IMRT [10%]; P < .001). Four patients receiving IMRT (2%) vs 0 receiving IMPT had a percutaneous endoscopic gastrostomy tube for longer than 6 months. Conclusions and Relevance: In this study, curative-intent radiotherapy with IMPT for nonmetastatic OPC was associated with a significantly reduced acute toxicity burden compared with IMRT, with few chronic toxic effects and favorable oncologic outcomes, including locoregional recurrence of only 5% at 2 years. Prospective randomized clinical trials comparing these 2 technologies and of patient-reported outcomes are warranted.

Outcomes and Toxicities of Nonmedullary Thyroid Tumors Treated with Proton Beam Radiation Therapy.

Purpose: Proton therapy is an emerging therapy for several malignancies owing to its favorable therapeutic ratio. There are very limited data on the use of proton therapy in the management of thyroid carcinoma. Our objective was to review the safety, feasibility, and outcomes of proton therapy for patients with thyroid cancer treated to the head and neck. Methods: From our institution's proton database from 2012 to 2021, we identified 22 patients with thyroid cancer treated with proton beam therapy. We evaluated outcomes and toxicities. Results: Median follow-up was 26 months. Of the 22 patients, 50% were female. The mean age was 65 years. Three patients had anaplastic cancer; 13, papillary carcinoma; 2, follicular carcinoma; and 2, poorly differentiated carcinoma. Forty-six percent had T4 disease. Primary targets were the central neck compartment, level VI, and upper mediastinum. Radiation dose was 60 GyRBE adjuvantly, and 70 GyRBE for gross disease (range, 6000-7600 GyRBE). Eight patients underwent upfront adjuvant radiation, and 3 received definitive radiation for unresectable disease upfront. Eleven patients received either salvage or palliative radiation. Fifty-nine percent of patients had extrathyroidal extension, and 64% of patients had gross disease in the neck before treatment. Fifty percent of patients had metastatic disease before treatment. Sixteen patients received concurrent chemotherapy, 63% of these patients received doxorubicin. For all patients, 1-year local regional recurrence (LRR) was 0%, and overall survival (OS) was 90%. Acute grade 3+ toxicities occurred in 27% of patients, the most frequent being dermatitis (27%). Three patients required a percutaneous endoscopic gastrostomy tube after radiation therapy (RT), 2 owing to progression. There were no grade 4+ toxicities. Conclusions: Proton therapy for thyroid cancer appears feasible and effective with minimal toxicities. Prospective studies comparing proton therapy with intensity-modulated RT, to evaluate the clinical efficacy of using proton therapy to reduce toxicities in patients undergoing radiation for thyroid cancer, are warranted.

The effect of short radiation treatment breaks on chemo-radiotherapy for oropharyngeal cancers.

BACKGROUND: Numerous studies and guidelines suggest an outcome detriment from radiation treatment breaks (rTBs) and the need for compensatory dosing in patients with head and neck cancer. METHODS: In a consecutive cohort of 521 patients with oropharyngeal squamous cell carcinoma (OPSCC), we investigated the impact of rTBs and prolongation of overall treatment time (OTT) on OS, DFS, LRC, and cancer recurrence using competing risk and multivariate analyses. RESULTS: Neither OTT prolongation by ≤2 days nor rTBs of ≤3 days were associated with detriments to clinical outcomes. Consecutive breaks of ≥3 days were also not significantly associated with detriment to clinical outcomes. There was significantly increased competing mortality in those with longer breaks. CONCLUSIONS: In OPSCC patients treated with definitive concurrent chemoradiotherapy, there is no significant association between disease failure and total rTBs of ≤3 consecutive or scattered days. Further investigation is needed for longer breaks.

Antibiotics to modify sickle cell disease vaso-occlusive crisis?

Despite the availability of hydroxyurea, the clinical use of the medication among patients with sickle cell disease (SCD) remains low in the United States. Given the high healthcare utilization cost, SCD requires new therapeutic approaches. Recent studies demonstrated bacterial overgrowth and dysbiosis-related intestinal pathophysiological changes in SCD. Intestinal microbes regulate neutrophil ageing. Aged and activated neutrophils contribute to the pathogenesis of vaso-occlusive crisis (VOC) in SCD. In this paper, we will review the pre-clinical and clinical data on how antibiotics might reduce the intestinal microbial density and influence the course of VOC. Based on these observations, we will discuss rationales for and potential challenges to antibiotic-based therapeutic approaches that may modify the clinical course of VOC in SCD.

Outcomes and prognostic factors of major salivary gland tumors treated with proton beam radiation therapy.

BACKGROUND: Proton beam radiation therapy (PBRT) has dosimetric advantages compared to photon radiation therapy for the treatment of major salivary gland tumors (MSGTs). METHODS: Patients with non-metastatic MSGTs treated at a single proton therapy center from October 2013 to October 2018 were retrospectively reviewed. RESULTS: Sixty-eight patients with MSGTs were included and the most common site and histology were the parotid gland (75.0%) and adenoid cystic carcinoma (22.1%), respectively. The 3-year rates of locoregional control, progression-free survival, and overall survival were 95.1% (95% CI: 89.9%-100.0%), 80.7% (70.2%-92.7%), and 96.1% (95% CI: 90.9%-100.0%), respectively. CONCLUSION: In a large cohort of MSGTs treated with PBRT, the rates of locoregional control were high in short-term follow-up and treatment was well tolerated.

Severe Hypophosphatemia Following Ferric Carboxymaltose in a Patient With Inflammatory Bowel Disease.

Inflammatory bowel disease is a chronic inflammatory condition that affects the large and small bowel, which includes Crohn's disease (CD) and ulcerative colitis (UC). Iron deficiency anemia (IDA) is one of the most common complications in people with inflammatory bowel disease. The treatment of choice is intravenous iron infusion. There is a lack of awareness of side effects of intravenous iron (Ferinject) such as hypophosphatemia, which can prolong hospital admission. We present the case of a patient with iron deficiency anemia and vitamin D deficiency who developed severe hypophosphatemia after intravenous injection of ferric carboxymaltose (Ferinject). In this case presentation, our aim is to increase the awareness of prescribers about the risk of developing low phosphate levels after Ferinject and the need to monitor serum phosphate levels.

Characterization and mutational analysis of haemagglutinin and neuraminidase of H3N2 and H1N1pdm09 human influenza A viruses in Egypt.

Seasonal influenza viruses constitute a major global concern. Currently, H3N2 and H1N1pdm09 are the commonly circulating influenza A viruses. The haemagglutin and neuraminidase genes of influenza A(H3N2) and A(H1N1)pdm09 viruses from Egyptian paediatric patients with respiratory distress were sequenced. Mutational analysis of all published sequences from Egypt was evolutionary tracked for both HA and NA genes. Phylogenetic analysis of H3N2 HA showed that the Egyptian strains belong to 3C2 subclade while Egyptian A(H1N1)pdm09 strains belong to 6B1 subclade. Some Egyptian A(H1N1)pdm09, 2013-2014, strains form a new subclade; 6B3. High score of mutations were recorded in HA of H1N1pdm09 but higher was recorded in H3N2 strains. These findings confirmed a high mutation rate of influenza A subtypes specially H3N2 strains.

Study of the relationship between urinary level of uromodulin, renal involvement and disease activity in patients with systemic lupus erythrematosus.

Systemic lupus erythematosus (SLE) is a multifactorial chronic inflammatory autoimmune connective tissue disease. Lupus nephritis (LN) is a common and serious complication of SLE which can progress to end-stage renal disease. Renal biopsy is the gold standard in the diagnosis and classification of LN, but since it is an invasive procedure, it is neither desirable nor applicable for all cases. This has led to the search for an alternative, noninvasive, site-specific, and immune process-related biomarkers. Uromodulin (Tamm-Horsfall glycoprotein) is the most abundant urinary protein expressed exclusively by the thick ascending limb cells and released into urine of healthy controls. Studies showed that it may act as a danger signaling molecule eliciting an inflammatory response following conditions that damage the nephron integrity and leading to uromodulin release into the interstitial space. This study aimed to assess uromodulin as a screening biomarker of tubulointerstitial involvement in patients with SLE and to elucidate its correlation with disease activity and progression. The study was conducted on 70 patients divided into two groups: control group (Group I) consisted of 20 apparently healthy volunteers of comparable age and sex to the patients' group, and 50 SLE patients (Group II) diagnosed according to the 2012 Systemic Lupus Collaborating Clinics (SLICC) classification criteria. Group II was further subdivided into 23 patients without manifestations of LN (Group II A) and 27 patients with manifestations of LN (Group II B). Urinary uromodulin level showed statistically significant difference among the studied groups, being lowest among the LN patients with a mean value 5.6 ± 3.4, in SLE patients without nephritis 9.9 ± 5.2 and 12.9 ± 4.6 in the control group. Urinary uromodulin also correlated positively with estimated glome- rular filtration rate. A negative correlation was found between urinary uromodulin and serum creatinine, 24 h urinary proteins and SLICC renal activity score. No statistically significant correlation was found between urinary uromo- dulin and SLE disease activity index. Thus, decreasing urinary uromodulin levels can be a marker for renal involvement and tubulo- interstitial nephritis in active SLE patients and a marker for chronic kidney disease and nephron loss in the absence of activity markers.

Health 4.0: On the Way to Realizing the Healthcare of the Future.

Health 4.0 establishes a new promising vision for the healthcare industry. It creatively integrates and employ innovative technologies such as the Internet of Health Things (IoHT), medical Cyber-Physical Systems (medical CPS), health cloud, health fog, big data analytics, machine learning, blockchain, and smart algorithms. The goal is to deliver improved, value-added and cost-effective healthcare services to patients and enhance the effectiveness and efficiency or the healthcare industry. Health 4.0 (adapted from the Industry 4.0 principles) changes the healthcare business model to enhance the interactions across the healthcare clients (the patients), stakeholders, infrastructure, and value chain. This effectively will improve the quality, flexibility, productivity, cost-effectiveness, and reliability of healthcare services in addition to increasing patients' satisfaction. However, building and utilizing healthcare applications that follow the Health 4.0 concept is a non-trivial and complex endeavor. In addition, advanced potential applications based on Health 4.0 capabilities are not yet being investigated. In this paper we define the main objectives of Health 4.0 and discuss advanced potential Health 4.0 applications. To have a clear understanding of these applications, we categorize them in 4 groups based on the primary beneficiary of these applications. Thus we have patient targeted applications, applications supporting healthcare professionals, resource management applications and high-level healthcare systems management applications. In addition, as we studied the different applications, we realized that these is a certain collection of services that these most of them need regardless of their goals or business context. Services supporting data collection and transfer, security and privacy, reliable operations are some examples. As a result we propose creating a service-oriented middleware framework to offers the common services to the applications developers and facilitate the integration of different services to build applications under the Health 4.0 umbrella.

Increased Prevalence of Cestode Infection Associated with History of Deworming among Primary School Children in Ethiopia.

Mass deworming of school-aged children with anthelmintics has been recognized as an effective approach for reducing the burden of soil-transmitted helminth (STH) infections. However, the consequences of this intervention on nontargeted parasite populations sharing the same gastrointestinal niche are unclear. We conducted a cross-sectional survey among three primary schools in Sululta town, Ethiopia, to examine the association between students' histories of deworming treatment in the past 6 months and the prevalence of cestode and protozoan infections. An interviewer-led questionnaire administered to parents provided information on sociodemographic factors, and deworming status was ascertained from school records. Stool samples were collected from 525 children for microscopic examination. The independent associations of "any cestode" (positive either for Hymenolepis nana or Taenia spp. eggs) and "any protozoan" (positive either for Giardia lamblia or Entamoeba histolytica/Entamoeba dispar) with history of deworming were examined using logistic regression. Overall, 25.9% of children were infected with at least one intestinal parasite of which H. nana was the most common. In multivariate analyses, deworming in the past 6 months was positively associated with increased odds of both "any protozoan" and "any cestode" infections; the latter reached statistical significance (AOR = 1.83, 95% CI: 0.69-4.86, P = 0.220, AOR = 3.82, 95% CI: 1.17-12.73, P = 0.029, respectively). If this observed association is causal, a greater understanding of interspecies interactions within the gastrointestinal niche may elucidate possible consequences of mass deworming treatments against STHs on coexisting nontargeted parasites.

Allergy-related disorders (ARDs) among Ethiopian primary school-aged children: Prevalence and associated risk factors.

BACKGROUND: There has been a noticeable increase in the prevalence of allergy-related disorders (ARDs) in the modern era. Urbanization is believed to be a major environmental risk factor for the onset of ARDs but data from low- to middle-income countries is limited. OBJECTIVE: Our purpose was to assess the prevalence of ARDs and atopy among a population of rural Ethiopian school children and identify environmental and lifestyle factors associated with such disorders. METHODS: We performed a cross-sectional study on 541 school-children. An interviewer-led questionnaire administered to the mothers of each participant provided information on demographic and lifestyle variables. Questions on allergic disease symptoms were based on the International Study of Asthma and Allergies in Children (ISAAC) core allergy and environmental questionnaire. Skin prick test for common allergens German cockroach (Blattella germanica) and dust mite (Dermatophagoides) was performed to define atopy. Multiple logistic regression analyses were performed to determine the odds ratio between ARDs and atopy with specific environmental and lifestyle habits. RESULTS: 541 children responded to the survey questions: the majority of participants were female (60.3%) and aged 10-15 years-old. The prevalence of any ARD was 27%, while the rates of ever-having eczema, rhinitis, and wheeze was found to be 16.8%, 9.6%, and 8.6% respectively. Only 3.6% (19 school-children) tested positive for any skin sensitization. Analysis of associated factors for ARDs found that a family history of allergic disorders (AOR: 2.80; p-value<0.01), use of insecticides (AOR: 2.05; p-value<0.01), and wearing open-toed shoes (AOR: 2.19; p-value = 0.02) were all significantly associated factors. Insecticide use, river-bathing, and infection with intestinal parasites were found to be significantly associated factors for atopy. Other potential risk factors such as frequent use of soap, bacterial infection, and household crowding had no statistical significance. CONCLUSION: Our study suggests that the prevalence of skin sensitization and ARDs in rural populations of developing countries is still relatively low. We identified several possible risk factors for further investigation. Overall, the significance of identified risk factors appears to indicate that genetic predisposition and exposure to environmental pollution are more important to the etiology of ARDs and atopy than specific lifestyle behaviors.