Alexandria University Research Articles

Does the contralateral testicular volume decide the need for diagnostic laparoscopy in cases of unilateral impalpable undescended testis?

BackgroundThis study aimed the evaluation of the value of the calculated volume of a normal testis to predict the status of its contralateral impalpable side and hence decide the importance of laparoscopic exploration.MethodsPatients with unilateral impalpable undescended testis – as confirmed by clinical and sonographic examination- were enrolled in our prospective interventional study between November 2018 and August 2022 at Elshatby University Hospital, Faculty of Medicine, Alexandria University. The volume and three-dimensional diameter of the normal contralateral testis were measured by the pre-operative US using the formula: Volume = L x W x H x π/6, where L is the length, W is the width, H is the height, and was correlated with the intra-operative laparoscopic findings.ResultsSeventy-six patients were included in our study. The age of the studied patients ranged between 6 months and 4 years with a mean of 2.17 ± 1.30 years; most of them were between one and three years old. Forty-six patients (60.5%) have left-sided impalpable testis and 30 patients (39.5%) have right-sided impalpable testis. The calculated volume of the contralateral normal testis was significantly larger in those patients who had both blind ending vas and vessels (0.89 ± 0.16) and in those who had an atrophic testis passing through the deep inguinal ring (DIR) –which was excised through the inguinal region- (0.83 ± 0.20) than in those patients who had their testes intra-abdominal (0.53 ± 0.18) or passing through the DIR to the inguinal region (0.80 ± 0.19). (Kruskal Wallis test; p < 0.001*).ConclusionsThe calculated sonographic volume of a normal testis can predict the status of its contralateral impalpable side significantly with sensitivity & specificity of 75.0% & 88.89% respectively and a cut-off point of ≤ 0.674; hence, helps in parent counselling preoperatively.Trial registrationName of the registry: Clinicaltrials.gov PRS. Trial registration number: NCT05933811. Date of registration: 10-7-2023 (retrospectively registered). URL of trial registry record: https://clinicaltrials.gov.

Effect of peppermint inhalation versus Swedish massage on chemotherapy induced-nausea and vomiting in children with leukemia: Multi-arm randomised trial design

BackgroundChemotherapy is the foremost treatment for children with leukemia, while causing different serious side-effects. Chemotherapy-induced nausea and vomiting are the most common deliberating side effects and critical concerns of pediatric oncology nurses among those children. AimTo investigate the effect of peppermint inhalation versus Swedish massage on chemotherapy-induced nausea and vomiting in children with leukemia. DesignA multi-arm randomised trial design with three parallel groups. SettingThis study was conducted at outpatient and inpatient Hematology/leukemia Units at Alexandria University Children's Hospital at Smouha. MethodsSeventy-five children with leukemia received the first chemotherapy session. They were randomly allocated into three equal groups, 25 children in each group (control, peppermint inhalation, and Swedish massage groups). Every child is assessed for nausea and vomiting before chemotherapy administration and after for three days for consecutive three sessions of treatment. ResultsStudy findings revealed that children in peppermint inhalation and Swedish massage groups showed significant reduction in mean total score of chemotherapy-induced nausea and vomiting among peppermint inhalation and Swedish groups (15.120 ± 4.585 and 14.680 ± 3.158, respectively) was observed on third chemotherapy session than in control group (45.680 ± 5.793) (p < 0.001). ConclusionIt can be concluded that Swedish massage and peppermint inhalation therapies may have significant antiemetic effects as alleviating the chemotherapy induced nausea and vomiting for children with leukemia. Practice implicationsThis study directs the pediatric oncology nurses to incorporate peppermint inhalation and Swedish massage therapies besides antiemetic drugs in pediatric oncology unit protocols for management of chemotherapy induced nausea and vomiting.

Correlation between pulp sensibility and magnetic resonance signal intensity following regenerative endodontic procedures in mature necrotic teeth- a retrospective cohort study

BackgroundWith increasing studies being published on regenerative endodontic procedures (REPs) as a treatment modality for mature necrotic teeth, the assessment of outcomes following regenerative endodontic procedures has become more challenging and the demand for a better understanding of the regenerated tissues following this treatment is rising. The study aimed to correlate cold, electric pulp testing (EPT), and magnetic resonance imaging (MRI) signal intensity (SI) in mature necrotic teeth treated with regenerative endodontic procedures.MethodologyThis retrospective cohort study included eighteen adult patients who experienced tooth necrosis in mature maxillary anterior teeth recruited from the outpatient clinic, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt from July 2017 until December 2018 with 12 months of follow-up. regenerative endodontic procedures via blood clot were performed. The canals were instrumented by ProTaper Next (PTN) files until final sizes X3 or X5. Biodentine was used as cervical plug material. Pre and post-operative clinical follow-up was done where the patients’ responses to cold and electric pulp testing were given a scoring system and were compared to the normal contralateral tooth. Pre and post-operative magnetic resonance imaging signal intensity of both the involved tooth and its contralateral at the middle and the apical thirds of the root canals were assessed after 3, 6, and 12 months. Data was analyzed using the ANOVA, Friedman and Bonferroni tests. Significance was set at a p-value < 0.05.ResultsAll 18 teeth scored a baseline score of “2” for cold and electric pulp testing. There was a significant difference between scores of the cold test at baseline and 12-month follow-up (p < 0.001). There was a significant difference between scores of the electric pulp testing of baseline and 12-month follow-up (p < 0.001). There was a moderately significant indirect (inverse) correlation between magnetic resonance imaging signal intensity and cold test in both the middle and apical thirds at 12 months. No significant correlations were detected between magnetic resonance imaging signal intensity and electric pulp testingat any of the time intervals (p > 0.05).ConclusionMagnetic resonance imaging is a successful non-invasive method to assess outcomes of regenerative endodontic procedures and correlating it with another reliable method of assessing pulpal responses, cold test, could validate these outcomes.Clinical trial registrationThe study was registered with ClinicalTrials.gov (ID: NCT03804450).

Endoscopic endonasal approach for skull base chordoma

BackgroundChordoma is a rare slow-growing malignant bone tumor that arises from embryonic notochordal remnants in the axial skeleton. Clival chordomas have a high propensity for extension through the skull base and a high proclivity for recurrence. Recently, resection of skull base chordomas through the endoscopic transnasal approach has become the standard way of managing these lesions with the new advancements in neuronavigation and reconstructive techniques in skull base surgery.MethodsIt is a retrospective study of all patients with clival chordoma that were operated upon using endoscopic endonasal resection at the Main Alexandria University Hospital during the period from March 2008 to April 2013. The extent of surgical resection was assessed intraoperatively and confirmed by the postoperative MRI study performed 8–12 weeks, 6 months, and yearly after the surgery.ResultsTwelve patients with clival chordoma were managed by endoscopic transnasal resection. Gross total resection confirmed by postoperative MRI was achieved in four cases, subtotal resection in six cases, and partial resection in two cases of clival chordoma. In cases where gross total resection was not achieved, residual tumors were adherent to vital neurovascular structures as confirmed with the utilization of an intraoperative imaging navigation device. A study of postoperative complications and possible recurrence was done for all cases.ConclusionsThe findings of this study highlight the significance of gross total resection as a major determinant for preventing the recurrence of chordoma. Our findings also support the validity of the endoscopic approach for the management of clival chordoma especially when the approach is tailored based on the site and extent of the tumor.

Clinical Characteristics and Appropriateness of Investigations in Children With Headaches at the Emergency Department

BackgroundIdentifying the cause of headaches in pediatric emergency departments (PEDs) can be challenging due to the lack of comprehensive research. This study aims to identify the frequency, characteristics, and unnecessary diagnostic procedures of patients with headaches in the PED setting. MethodsA six-month cross-sectional study was conducted at the PED of Alexandria University Children's Hospital, including all children with headaches. Children were classified as having primary headache (PH), secondary benign headache (SBH), and secondary serious headache (SSH) according to predetermined criteria. Logistic regression was employed to analyze the risk factors associated with SSH. ResultsA total of 164 visits to the PED were recorded, out of a total of 22,662 visits, accounting for approximately 0.72% of all visits and 1.17% of the total number of children admitted. PH was the most common cause, accounting for 61.0% of cases, followed by SSH with 24.4%, whereas SBH was the least common with 13.4%. Abnormal neurological examination (odds ratio, 53.752 [1.628 to 1774.442], P = 0.026∗) was found to have a strong and statistically significant association with SSH in the multivariate analysis. Regarding the appropriateness of the investigations conducted, it was found that over half (66.5%) of the cases had unnecessary neuroimaging, with 52% of these cases being children with PH. ConclusionsHeadaches in children are commonly reported during visits to the PED. PH was the most prevalent, followed by SSH, whereas SBH was the least common. Many of the children received inaccurate first diagnoses and performed unnecessary laboratory tests, neuroimaging, and other tests, mostly electroencephalography.

Performance of the IOTA ADNEX model in preoperative assessment of suspicious adnexal masses with high-risk of malignancy index in Alexandria University Gynecology Oncology Center: a prospective study

Performance of the IOTA ADNEX model in preoperative assessment of suspicious adnexal masses with high-risk of malignancy index in Alexandria University Gynecology Oncology Center: a prospective study

Is Elastic Stable Intramedullary Nailing a Viable Treatment Option for Diaphyseal Fractures of the Humerus in Adults? A 29-case Series Prospective Study.

Humerus shaft fractures are common in orthopaedic practice. The emphasis in treatment has shifted from prolonged immobilisation to early mobilisation and internal fixation when needed for a quicker return to normal function. Internal fixation methods include plate osteosynthesis and intramedullary nailing. This study specifically evaluated the effectiveness of flexible intramedullary nails in treating diaphyseal humeral fractures. Between April 2007 and January 2010, Alexandria University Hospital treated 29 patients (21 males, 8 females) with diaphyseal humeral fractures. Treatment involved closed reduction and percutaneous fixation using two flexible nails. Patients, aged 17 to 65 with a mean age of 32, were included if they did not have pathological fractures, were above 16 years old, and were medically suitable. Causes included pedestrian vehicle accidents (17 cases) and falls or sports-related activities (12 cases). Surgical intervention occurred 1 to 8 days after the injury. Between April 2007 and January 2010, Alexandria University Hospital treated 29 patients (21 males, 8 females) for diaphyseal humeral fractures using closed reduction and percutaneous fixation with two flexible nails. Patients, aged 17 to 65, were monitored for an average of 18 months. Radiographic assessments showed complete union in nineteen fractures within 13 to 21 weeks. One patient experienced non-union but was successfully treated with bone grafting and plating. There were no significant intraoperative complications. Notably, four patients with preoperative radial nerve injuries recovered within 6 to 8 weeks. Evaluation using the Stewart and Hundley Scoring technique showed excellent outcomes for 60% of patients, good outcomes for 30%, fair outcomes for 5%, and poor outcomes for 5%. 1.The Elastic Stable Intramedullary Nailing (ESIN) technique shows promise in the treatment of humeral shaft fractures. 2. However, the success of treatment may depend on various factors, including patient age, fracture characteristics, and the presence of complications such as open fractures and radial nerve palsy. 3. Careful consideration of these factors is necessary when selecting a treatment approach for humeral shaft fractures.

Biology of Nicotiana glutinosa L., a newly recorded species from an archaeological excavation site in Egypt

BackgroundDuring a field survey of urban flora in Alexandria city in 2019–2022, an interesting species belonging to the Solanaceae was collected from a newly archaeological excavation site and identified as Nicotiana glutinosa L. Many visits were made to the herbaria of Egypt to confirm the species records, but no single record was found. Reviewing the available literature revealed that this tropical American taxon was never recorded in the flora of Egypt.AimsThe present study was focused on N. glutinosa growth structure and plant macro- and micromorphology.MethodsTen sampling sites were covered for N. glutinosa size structure. Plant samples were examined for stem anatomy, leaf, seed, and pollen morphology.ResultsThe species size structure reveals that the individual size index ranges from 1.33 to 150 cm, while its density ranges from 4 to 273 individuals /100 m−2.N. glutinosa has successfully established itself in one of the archaeological sites in Egypt, showing a “healthy” population with a high degree of size inequality, characterized by a relative majority of the juvenile individuals. Voucher specimens were deposited in the Herbarium of Alexandria University (ALEX) Faculty of Science, another specimen is processed to make herbarium specimens at the Herbarium of the Botanic Garden (Heneidy et al. collection, deposition number. 5502).ConclusionsFrom our observations, N. glutinosa seems to have invasive potential, as it shows characteristics shared by most invasive species that are thought to help in their successful establishment in new habitats. This article emphasizes the importance of monitoring and regularly reporting the threats of alien invasive species to avoid any possible negative impacts on indigenous biodiversity in the future.

Trends and predictors of antimicrobial resistance among patients with urinary tract infections at a tertiary hospital facility in Alexandria, Egypt: a retrospective record-based classification and regression tree analysis

BackgroundThe incidence of Antimicrobial Resistance (AMR) in uropathogens varies between countries and over time. We aim to study the patterns and potential predictors of AMR among patients with UTIs admitted to the Urology Department at Alexandria University Hospital.MethodsAn observational retrospective record-based study was conducted on all patients admitted to the Urology department from October 2018 to October 2020. Data collected from patients’ records included: demographic data, diagnosis on admission, history of chronic diseases, duration of hospital stay, insertion of a urinary catheter, duration of the catheter in days, history of the use of antibiotics in the previous three months, and history of urinary tract operations. If UTI was documented, we abstracted data about urine culture, use of antibiotics, results of urine cultures, type of organism isolated, and sensitivity to antibiotics. We conducted a multivariable logistic regression model. We performed Classification and Regression Tree Analysis (CART) for predicting risk factors associated with drug resistance among patients with UTI. Data were analyzed using SPSS statistical package, Version 28.0, and R software (2022).ResultsThis study encompassed 469 patients with UTIs. The most commonly isolated bacterium was Escherichia coli, followed by Klebsiella pneumoniae. Multidrug resistance (MDR) was found in 67.7% (149/220) of patients with hospital-acquired UTIs and in 49.4% (83/168) of patients with community-acquired UTIs. Risk factors independently associated with antimicrobial resistance according to logistic regression analysis were the use of antibiotics within three months (AOR = 5.2, 95% CI 2.19–12.31), hospital-acquired UTI (AOR = 5.7, 95% CI 3.06–10.76), diabetes mellitus (AOR = 3.8, 95% CI 1.24–11.84), age over 60 years (AOR = 2.9, 95% CI 1.27–6.72), and recurrent UTI (AOR = 2.6, 95% CI 1.08–6.20). Classification and regression tree (CART) analysis revealed that antibiotic use in the previous three months was the most significant predictor for developing drug resistance.ConclusionThe study concluded a high level of antimicrobial resistance as well as significant MDR predictors among hospitalized patients with UTIs. It is vital to assess resistance patterns in our hospitals frequently to improve rational antibiotic treatment as well as to sustain antimicrobial stewardship programs and a rational strategy in the use of antibiotics. Empirical therapy for UTI treatment should be tailored to the potential pathogens’ susceptibility to ensure optimal treatment. Strategic antibiotic use is essential to prevent further AMR increases. Further research should focus on suggesting new biological systems or designed drugs to combat the resistance of UTI pathogens.

The correlation between the frequent intake of dietary migraine triggers and increased clinical features of migraine (analytical cross-sectional study from Egypt)

Despite the high prevalence of primary headaches, the role of food in modifying clinical characteristics among migraine patients is often overlooked. The aim is to detect the correlation between adopting unhealthy dietary habits and migraine severity and identify foods that have a greater chance of triggering specific subtypes of migraine. The present study was a cross-sectional analytical study that was conducted at Kasralainy Hospital, Cairo University, headache clinic at Alexandria University Hospital, and Al-Azhar University Hospitals from January to June 2020. We included 124 patients fulfilling the ICHD-3 criteria for migraine. A full clinical profile for migraine headaches was reported using a headache sheet applied to the Al-Azhar University headache unit. A nutritionist obtained data collected about dietary habits using many reliable scales and questionnaires such as food frequently sheets questionnaire. Logistic regression and Pearson correlation coefficients have been used to identify foods that are more likely to be associated with increased clinical features of migraine. Our participants reported that the fried meat, fried chicken, processed meats, fava beans, falafel, aged cheese “Pottery salted cheese” and “Rummy cheese”, salted-full fatty cheese “Damietta cheese”, citrus fruits, tea, coffee, soft drinks, nuts, pickles, chocolate, canned foods, sauces, ice cream, smoked herring, in addition to the stored food in the refrigerator for many days were significantly associated with the diagnosis of chronic migraine CM compared to episodic migraine (EM). Margarine, pickles, and smoked herring were significantly associated with the diagnosis of migraine with aura (MA) compared to migraine without aura (MO). Adopting unhealthy eating habits was a more prevalent dietary consumption pattern among people with chronic migraines compared to those with episodic migraine.

Using 7Be and 137Cs for Assessing the Land Stability of Alexandria Region, Egypt

This paper presents an assessment of land stability using fallout environmental radioisotopes 7Be and 137Cs. The measurement of both isotopes was carried out in samples of soil collected from twenty-five sites covering the studied region. At each site, the samples were taken from five consecutive vertical depth levels to show the vertical displacement or compactness of the soil column. The collected samples were carefully transferred for radioactivity measurement at Alexandria University’s Institute of Graduate Studies and Research. A high-resolution gamma-ray spectrometer utilizing high-purity germanium was employed for the measurements. Surface distribution of the radionuclides levels was used to show the studied lands’ stability over the short- and long-term based on the used radionuclides’ nuclear half-life. For short-term (months) stability, 7Be (half-life: 35.5 days) levels showed that about 73% of the area is very low in stability, while the areas that recorded low, moderate, and high stability are at 18%, 4%, and 5%, respectively. For long-term (years) stability, 137Cs (half-life: 30 years) levels showed that about 80% of the areas are very low in stability, while the remaining areas, predicted as 12.8%, 5.6%, and 1.6%, are low, moderate, and high stability, respectively. It is clear that the eastern side of Alexandria is suffering from soil erosion and subsidence; on the other hand, the western side is more stable. Consequently, due to the origin of the soil, the nature of soil geological formations, and the environmental prevailing conditions, Alexandria is found to be more vulnerable to the consequences of sea-level rise and climate change. Therefore, adequate strategic management, including mitigation measures and adaptation, should be planned and implemented.

Naturalization and invasion potential of Sesuvium portulacastrum L. recorded as alien species in Egypt

Sesuvium portulacastrum is a perennial halophyte of family Aizoaceae, non-native to Egypt, which was introduced from France ten years ago as an ornamental species. This study reports the detection of S. portulacastrum in the wild in Egypt. Voucher specimens were deposited in the Herbarium of Alexandria University (ALEX). A population of the species was recorded in the wild near Maruit Lake in the north-western coast of Egypt in 2018 during plant resources surveys of the region. The study aimed to assess the potential for S. portulacastrum to spread as an alien species through field observations and geospatial measurements under current conditions in its new habitat. The measured morphological parameters were higher than those recorded in its native habitats. The field observation for three years revealed that the species is proliferating and expanding in the investigated site forming large mats of mean size of up to 9 m2. The spatial extent of S. portulacastrum based on the EOO and AOO was quantified, and the expansion rate was estimated at 0.16 ha/year in the investigated site. The geospatial parameter used in the study will not only help in determining the spread rate of the alien species spatially and temporally, but also in its effective management through guiding managers in developing monitoring plans for the species under the changing climate uncertainty. Continuous monitoring and early detection of any potential threats of the introduced species are highly recommended, to avert any potential adverse impacts on native biodiversity and assess its behaviour in the wild habitat.

The malnutrition screening tool STRONGKIDS performed better than other screening tools for children hospitalised in Egypt.

To compare the accuracy of three different screening tools, namely, the Paediatric Yorkhill Malnutrition Score (PYMS), Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), and Screening Tool for Risk on Nutritional Status and Growth (STRONGKIDS), in assessing malnutrition risk in hospitalised children. A cross-sectional study was conducted on 300 children aged 6 months to 15 years at Alexandria University Children's Hospital, Egypt. The sensitivity and specificity of each tool were calculated to detect acute and chronic malnutrition, and an agreement test was conducted between the nutritional screening tools. The patients were classified into different nutritional risk groups, and their classification was compared with anthropometric measures and clinical variables, such as the length of hospital stay (LOS). The prevalence of stunting and wasting on admission was found to be 3% and 6.6%, respectively. Children categorised as high-risk on admission had a longer LOS than those at low risk. The agreement test between the STAMP score and STRONGKIDS score on admission showed the most significant agreement, and STRONGKIDS had the best accuracy in detecting acute and chronic malnutrition. The comparison of the three screening tools revealed that STRONGKIDS exhibited the best accuracy in detecting acute and chronic malnutrition.

MYELOID-DERIVED SUPPRESSOR CELLS TWO YEARS AFTER HEPATITIS C VIRUS ERADICATION USING DIRECTLY ACTING ANTIVIRALS.

Myeloid-derived suppressor cells (MDSCs) have immature morphology, relatively weak phagocytic activity, as well as some immunosuppressive functions. The capacity of MDSCs to inhibit T-cell-mediated immunological responses is their most notable functional characteristic. Down-regulating antitumor immune surveillance is one way that the expansion and activation of MDSCs contribute significantly to the occurrence and progression of tumors. Increased levels of MDSCs in patients with chronic hepatitis C virus (HCV) infection could suppress T-cell responses, promoting viral escape and hepatitis progression. This may make HCV-infected individuals more vulnerable to severe infections, hepatic and extra-hepatic tumors, and a diminished capacity to react to immunization. It is still unknown if effective HCV eradication with directly acting antivirals (DAAs) can restore immune functions and immune surveillance capacity. The purpose of this study was to observe the frequency of M-MDSCs (CD33+, CD11b+, and HLA-DR) in patients with a previous history of HCV, 2-3 years after virus eradication using DAA therapy. This study was conducted on 110 subjects: fifty-five subjects without liver cirrhosis who were treated with HCV using DAAs and attained SVR for a period of 2-3 years and 55 age- and gender-matched healthy controls. The study was conducted during the period from January to July 2022. Patients were recruited from the National Viral Hepatitis Treatment Unit, Alexandria University Hepatology outpatient clinic, and the Alexandria University Tropical Medicine outpatient clinic. The frequencies of MDSCs (CD33+CD11b + HLA-DR-) by flow cytometry were assessed. Even after the virus had been eradicated for longer than two years, MDSC levels in HCV-treated individuals were found to be considerably higher. In the HCV-treated group, the median number of MDSCs was 5, with an interquartile range (IQR) of 3.79-7.69. In contrast, the median for the control group was 3.1, with an IQR of 1.4-3.2 (P˂0.001). Successful DAA therapy leads to slow and partial immunological reconstitution, as demonstrated by the failure to attain normal levels of MDSC's 2 years after successful HCV eradication despite the normalization of laboratory parameters as well as the absence of liver fibrosis. The clinical implications of these findings should be thoroughly studied.

Assessment of thyroid function in children and adolescents with chronic liver diseases

Introduction The majority of hepatic patients are clinically euthyroid. However, liver disorders may alter thyroid hormone metabolism, including substantial abnormalities of either euthyroid sick syndrome (ESS), autoimmune thyroid disorders, or subclinical hypothyroidism (SH). But there are few studies conducted on children with chronic liver diseases (CLD) to assess thyroid functions. Aim The study aimed to evaluate thyroid profiles in patients with CLD. Patients and methods An observational, cross-sectional study including patients with CLD attending Hepatology Clinic at Alexandria University Children’s Hospital from June 2021 to June 2022. One hundred and two children were included and a history taking and clinical examination were performed. Assessment of severity using a modified Child–Pugh score was done. Laboratory investigations in the form of liver, lipid, and thyroid profiles were done. Results One hundred and two children with CLD were included in this study, 50 (49.0%) females and 52 (51.0%) males. The most common diagnosis in the studied cases was autoimmune hepatitis (24.5%), followed by glycogen storage disease. Out of 14 (13.7%) aberrant outcomes of thyroid function, seven (6.9%) patients had ESS, and seven (6.9%) individuals had SH. By univariate analysis, alkaline phosphatase and serum albumin level were significant risk factors for SH. Furthermore, melena and hepatic encephalopathy were significant risk factors for ESS. Conclusion Thyroid dysfunction might occur in CLDs either in the form of SH or ESS. The prevalence of thyroid disease in children with CLD exceeded 10%, which signifies the importance of screening for thyroid dysfunctions in this cohort.

Psychological Impact of COVID-19 on Dental Graduates: A Cross-Sectional Study.

Background The pandemic-induced physical closure of educational institutions led to challenges for senior dental students that might affect their psychological status. This study aimed to assess stress, anxiety, and subjective worries among dental interns post-COVID-19. Methodology A self-structured questionnaire was sent to Alexandria University and Taibah University dental interns. The questionnaire included sociodemographic data, self-reported comorbidities, behavioral risk factors, Kessler Psychological Distress Scale (K-10), Generalized Anxiety Disorder 7-Item (GAD-7) scale, and future subjective worries regarding the dental profession post-COVID-19. Results A total of 129 interns participated, with the majority (79.1%) being females. Overall, 90.7% were unmarried, 80.6% lived with a family, 93.8% were free from systemic comorbidities, 82.17% were satisfied with their current life, and 63.6% felt positive quite often. K-10 distress levels were reported as very high (38%) and high (33.3%), and perceived satisfaction with current social life was significantly associated with moderate-to-high distress levels. Feeling positive about life quite often was significantly associated with very high distress levels. Mild GAD-7 anxiety levels were reported in 40.3% and were significantly associated with females, who perceived positive satisfaction with their current social life and felt positive about life. Most agreed that their profession would be risky, their ability to perform their job to the best would be jeopardized, and they would need extra precautions in clinical training post-COVID-19; however, they disagree with postponing their training until COVID-19 cases declined entirely. Conclusions Dental interns were affected by the lockdown, especially female interns. Psychological therapy is advised for stressed dental students.

The four-way approach of tourism students towards a post–Covid-19 world and the future of tourism

This study explores current tertiary tourism students’ post-pandemic career strategies and their visions towards Egypt’s post–Covid-19 tourism future. The data were collected through 29 semi-structured in-depth interviews with 29 students majoring in tourism management at the University of Alexandria, Egypt. Findings demonstrate that in order to adapt to the tourism workforce in post–Covid-19 Egypt, students adopted a four-way approach: a dual temporal perspective, individual agency, parental support and active imagination of lifelong careers and reimagining the future of Egypt’s tourism in the post-pandemic era. The four approaches are conceptualized in relation to participants’ strategies and concerns towards future career paths and the Egyptian tourism industry in the post-viral world. In this regard, students’ perceptions can guide policymakers, hotel professionals and government agencies to develop post-pandemic strategies and programs to meet the changing needs and expectations of post-pandemic tourists, as well as students. Finally, the study indicates avenues for future research directions related to the findings and limitations.

Relation between the Epicardial Fat Thickness and the Cardiac Conduction System in Children and Adolescents with Diabetes

Introduction: Atherosclerosis in patients with type 1 diabetes starts early in childhood with subclinical abnormalities. The epicardial fat thickness (EFT) is a novel method for detecting these early changes. Furthermore, electrocardiographic markers may be altered in patients with diabetes owing to early cardiovascular changes. This study aimed to determine the relationship between EFT and electrocardiographic markers in children with type 1 diabetes mellitus. Methods: Children with type 1 diabetes who were followed up at the Alexandria University Children’s Hospital Diabetes Clinic were enrolled in this study. The study recruited three groups of participants, including 20 patients with a diabetes duration of less than 5 years, 20 patients with a diabetes duration of 5 years or more, and 20 healthy controls. All participants were evaluated with emphasis on anthropometric measurements, fasting blood glucose levels, and lipid profile. HbA1c levels were measured in the cohort with diabetes. All participants underwent electrocardiography for measurement of P-wave dispersion, corrected QT interval and its dispersion, and Tp-e measurement. Echocardiography was performed to measure the EFT. Results: Among all participants, EFT was significantly higher in children with a diabetes duration of ≥5 years (p = 0.009). Furthermore, P-wave dispersion was significantly prolonged in children with diabetes compared to that in nondiabetics (p = 0.041). There was a statistically significant correlation between EFT and P-wave dispersion in patients with diabetes aged ≥5 years (p = 0.021). Conclusions: Measurement of EFT by echocardiography is a novel and easy way to predict early cardiovascular changes in children with diabetes, including conduction system disorders.

Factors affecting on the duration of Ventilation among Mechanically Ventilated Patients Zeinab Hussein Ali *, Taisser Zaiton, ** Ekram Mahmoud Shalash*** Professor of Adult Health Nursing, Faculty of Nursing Helwan University*, Professor of Critical Medicine, Faculty of Medicine, Alexandria University**, Assistant Lecturer of Critical Care and Emergency Nursing, Faculty of Nursing Tanta University***

Factors affecting on the duration of Ventilation among Mechanically Ventilated Patients Zeinab Hussein Ali *, Taisser Zaiton, ** Ekram Mahmoud Shalash*** Professor of Adult Health Nursing, Faculty of Nursing Helwan University*, Professor of Critical Medicine, Faculty of Medicine, Alexandria University**, Assistant Lecturer of Critical Care and Emergency Nursing, Faculty of Nursing Tanta University***

The effectiveness of Carie-Care™, chemomechanical caries removal technique in primary teeth: randomized controlled clinical trial

BackgroundChemomechanical techniques for caries removal have been introduced to overcome the shortcomings of the conventional rotatory instruments. This study aimed to clinically evaluate the effectiveness of the chemomechanical method of caries removal (Carie-Care™) over mechanical caries removal through the Atraumatic Restorative Technique in pediatric patients.MethodsA randomized controlled clinical trial was conducted. Fifty children fulfilling inclusion criteria were recruited from the outpatient clinic of Pediatric and Dental Public health department, Faculty of Dentistry, Alexandria University. Fifty open carious primary molars were randomly assigned into 2 equal groups according to the method of caries removal. In Group I (test group), caries was removed using the Carie-Care™ system and in Group II (control group), by using mechanical caries removal through the atraumatic restorative technique. Resin modified glass ionomer was used for teeth restoration, the two techniques were compared in each child according to time taken for caries removal, efficacy of caries removal, pain assessment, and child behavior.ResultsThe mean time taken for caries removal in the Carie-Care™ treatment group was (575.6 ± 114.8) seconds which was statistically significant higher as compared with the ART treatment group (346.1 ± 97.4) seconds (p < 0.001). The mean score of efficacy in caries removal was (0.6 ± 0.8) in the Carie-Care™ group, and (1.3 ± 0.7) in the ART treatment group. When compared to ART, Carie-Care™ was significantly more efficient in caries removal (p < 0.002). When pain was assessed by the SEM scale, it was observed that the Carie-Care™ caries removal technique showed statistically significantly more comfort during the procedure compared with the ART procedure (p < 0.001).Moreover, children in the Carie-Care™ group enjoyed the process and showed more cooperative behavior when assessed at the end of procedure than those in the ART group with statistically significant difference (p = 0.002).ConclusionsRemoval of carious tissue in primary teeth using Chemomechanical Carie-Care™ gel proved to be more time consuming than ART, but on the other hand it was more efficient, comfortable, and accepted by the pediatric patients.