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Social Media Adoption by SMEs in Saudi Arabia: Organizational Perspective

Dr. Sanaa S. Askool

College of Computer & Cyber Science, University of Prince Mugrin, Al-Madinah, Saudi Arabia

s.askool@upm.edu.sa

Abstract: Social media platforms are considered as effective innovations that offer significant advantages for small and medium enterprises (SMEs) such as reaching new markets and customers, promoting their products and brands, and improving the quality of communication. Currently, organizations have become aware of social media influence which will help them to develop long meaningful relationships and to improve the firms’ performance. However, some risks can be highlighted such as firm culture, security and privacy issues. The increase in the use of social media has encouraged both individuals and businesses to take advantage of them. Many SMEs around the world have implemented new services using these tools to expand their existing marketing strategies, attract new customers, and improve their reputation. As more and more companies are using social media to improve their business activities, it is important for enterprises to highlight factors that influence corporate intentions to adopt social media. Therefore, the main objective of this research was to identify the factors that encourage SMEs to use social media as these can be useful tools for improving existing and future business functions. A model for exploring and predicting the use of social media has been presented in this research based on the TOE framework and IDT which help in achieving a better understanding of IT adoption. Drawing from the innovation adoption literature, a range of factors that might influence SMEs’ intention to adopt social media were identified and tested. Saudi SMEs have recognized the importance of social media and have thus used them for several objectives. The findings of this study indicate that social media technology, organizational, and environmental contexts contribute to social media adoption and use, which can be used as a foundation of future work in terms of developing and implementing social media platforms. This research has contributed to the existing literature by providing a model that can be used to analyze an organization’s behavior towards the use of social media for SMEs, which is quite different from other models such as TAM and UTAUT that focus on individuals’ behavior. These models can also be used to study the role of social media adoption on the companies’ performance.

[Sanaa S. Askool. Social Media Adoption by SMEs in Saudi Arabia: Organizational Perspective. J Am Sci 2019;15(12):1-16]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 1. doi:10.7537/marsjas151219.01.

Keywords: Social; Media; Adoption; Saudi Arabia; Organizational Perspective

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Role of MRI in Evaluation of Ankle Joint Injuries

Omnia A. Kamal¹, Hosam M. Sakr¹ and Abdulmuati A. Alameri^2*

¹ Professor of Radiodiagnosis, Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University, Egypt.

² M. B. B. CH, Sana’a University, Yamen.

alsameye22@gmail.com

Abstract Background: The ankle joint is one of the most frequently injured joints, where ankle sprains are frequently encountered in individuals playing sports, in addition to occurring in the general population. Magnetic resonance image (MRI) is an excellent tool for imaging of the bones, tendons, ligaments, and other structures of the ankle joint as it can demonstrate pathologies before they become evident on other imaging modalities. Aim of the Work: The purpose of this study was to highlight the role of MRI in evaluation of ankle joint injuries. Patients and Methods: Thirty patients were included in our study. They were suffering from (recent/old) ankle joint trauma. This study was conducted from September 2018 till July 2019 at MRI unit, department of Radiology. Ain Shams University hospitals. MRI examination was performed in the axial, coronal, and sagittal planes at different pulse sequences. Results: This study included 30 patients. 17 had bone injury, 11 showed tendons injury, and 15 with ligaments injury, 12 had joint effusion and miscellaneous injuries in 5 patients. Conclusion: MRI is the primary imaging modality of choice in assessment of ankle joint trauma due to its excellent soft tissue contrast for optimal detection of pathologies of the tendons, ligaments, and other soft tissue structures of the ankle joint complex. MRI is capable of diagnosing most of the ankle joint osseous abnormalities such as bone contusion, stress and insufficiency fracture before being evident in other imaging modalities.

[Omnia A. Kamal, Hosam M. Sakr and Abdulmuati A. Alameri. Role of MRI in Evaluation of Ankle Joint Injuries. J Am Sci 2019;15(12):17-27]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 2. doi:10.7537/marsjas151219.02.

Key words: Ankle Joint trauma, ligament, tendon injuries, bone marrow edema

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Alleviation of Deadly Hazards of Rip and Circulation Currents Using Near Shore Self Lighting Floating Units

Reda M. A. Hassan¹, and Shaymaa E.T. Hassan²

¹Ph.D., Professor Ass., Coastal Research Institute, National Water Research Center, Egypt

²Researcher Assistant, Coastal Research Institute, National Water Research Center, Egypt

E-mail: Doctor_reda2010@yahoo.com, eng_shaymaa2004@hotmail.com.

Abstract: Ripand circulation currents occur every day on many beaches and not only after a storm or at high tide. Losses due to drowning from currents in particular rip and circulation currents are the most important hazard on global beaches; it is a major cause of surf drowning. In the United States, the currents kill nearly 200 to 500 people every year. In Costa Rica Analysis of data from the Judicial Investigation Organization of Costa Rica indicates that drowning is the leading cause of violent death in the country, with 1,391 drownings between 2001 and 2012. Approximately 590 of those drownings occurred in a marine environment and are listed as being the result of rip currents. In Egypt, according to official data from the Central Agency for Public Mobilization and Statistics (CAPMAS) issued in 2018 drowning accidents and immersion in water unintentionally is about 7% from total different accidents in Egypt, around 1054male and 220 female with total 1274people are drowned via drowning accidents. Study of the near shore is important in areas, where the coastline is influenced by erosion and accretion. These erosion and accretion need some protection structures like groins and detached breakwaters, which cause more circulations and rip currents. Many studies had been carried out to solve problem of rip current, but the problem still exist. This present study assesses the possibility of using new technique as a possible solution for the problems of drowning; also, it presents a vision for decision maker, using a new tool to alleviate the deadly hazards of circulation phenomena and rip currents. For this reason, finding a suitable tool to mark rip currents is important for warning the swimmers, from the possible hazards due to swimming in the path of rip currents. Furthermore, the objective of this research is determining the hazard area around marine structures of shore protection like groins and breakwaters as well as, the calculation of the characteristics of rip current like its influence distance and its minimum and maximum velocities. The proposed tool is floating self-lighting units, which can generate and save energy for lighting from energy of waves and different currents. The units can be positioned and arranged in the path of rip current, in particular the neck and head area of rip current. Achieving the goals of this research, field measurements had been carried out, also detailed observations of the effects of long shore varying bathymetry on near shore circulation. For this purpose numerical models (MIKE 21- SW) and (MIKE 21- FM) were applied on Rosetta promontory (eastern groin), and Baltim coast to determine the current direction and velocity, and also to investigate the circulation flow in the mentioned areas to avoid the dangerous effects of drowning for the swimmers. In addition, experimental work was performed at the physical model lab of Abu Quir research station, Alex. Egypt. The objective of the experiments is studying the stability of proposed floating units using different wave heights, water depth, and different diameters of units. It is concluded after the analysis of data that, the current’s velocities beside the breakwaters are almost large values, where the speed of the rip currents can be 0.5 m/sec up to 1.50 m/sec and extend to 30 m up to 150 m towards the sea (in Egypt). It is recommended that for decision makers, the proposed floating units can be a tool for the reduction of hazard due to rip and circulation currents. For swimmers, be watchful at all times, especially when swimming at unguarded beaches. It is required to characterize the rip hazard at the most popular beaches on the coastal zone in Egypt.

[Reda M. A. Hassan, and Shaymaa E.T. Hassan. Alleviation of Deadly Hazards of Rip and Circulation Currents Using Near Shore Self Lighting Floating Units. J Am Sci 2019;15(12):28-38]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 3. doi:10.7537/marsjas151219.03.

Keywords: Ripand circulation currents-Drowning near structures –Marine floating units-Egypt.

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Neutrophil/Lymphocyte and Platelet/Lymphocyte ratios and their relation with disease activity in Systemic Lupus Erythematosis patients

Yosri Zaki El-Zohairy¹, Ehab Abdul Aziem Ahmed², Amr Ahmed Rezk¹, Osama Hassan Mohmed¹

¹Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

²Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

drosamahassan1@gmail.com

Abstract: Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. Some evidences suggest that neutrophil-lymphocyte ratio (NLR) associated with different inflammatory malignancies, ischemic injury and cardiovascular disease. Few scholars have investigated the relationship between NLR and SLE. Aim of the study: This study aimed to evaluate the role of NLR and PLR in SLE activity assessment. Methods: A total of 45 subjects were participated in this study. 30 diagnosed with SLE in patients group and 15 healthy age-and sex-matched in control group. NLR and PLR levels between SLE patients in both remission and excerptions (according to SLEDEI score) and healthy controls were compared, and correlations between these indices and clinical characteristics were analyzed. Results:  increased NLR and PLR were observed in SLE patients. NLR was positively correlated with antinuclear antibodies (ANA) (r = 0.4, p= 0.03), C3(r = -0.56, p= 0.001), C4 (r =  -0.49, p= 0.01) and erythrocyte sedimentation rate (ESR) (r=0.63, p<0.001) ,SLEDAI scores(r=0. 0.53, p<0.001). PLR was positively correlated with with antinuclear antibodies (ANA) (r = 0.43, p= 0.02), Anti-d.DNA antibodies(r = 0.36, p= 0.049), C4 (r = -0.45, p= 0.01) and SLEDAI scores(r=0.445, p<0.001).Conclusion: NLR and PLR could reflect inflammatory response and disease activity and disease damage in SLE patients.

[Yosri Zaki El-Zohairy, Ehab Abdul Aziem Ahmed, Amr Ahmed Rezk, Osama Hassan Mohmed Neutrophil/Lymphocyte and Platelet/Lymphocyte ratios and their relation with disease activity in Systemic Lupus Erythematosis patients. J Am Sci2019;15(12):39-45]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org.4. doi:10.7537/marsjas151219.04.

Keywords: Neutrophil/lymphocyte, platelet/lymphocyte, systemic Lupus erythematosus

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Comparison between circulating biomarkers Serum CRP and Plasma Fibrinogen levels In Malignant Pleural Mesothelioma patients Before and After Surgical and Chemotherapy Modalities

Prof. Dr. Ahmad Anwar El Noury, Dr. Hany Hasan Mohamed El Sayed, Dr. Ahmad Mohamed Mohamed Mostafa, Ahmad Mosaad Zaky

Cardiothoracic Surgery Department, Faculty of Medicine, Ain Shams University, Egypt

Mayar mattar92@gmail.com

Abstract: In our study we are measured a novel blood biomarkers as Serum CRP, And Plasma Fibrinogen levels of MPM patients, initially and after one month of treatment even surgical or chemo radiotherapy in multimodality therapy. In our study we are found that Plasma Fibrinogen is a significant biomarker of MPM to determine the prognosis of MPM patients, and determine the efficacy and the achieved benefits of surgical treatment for that patients. And Plasma fibrinogen levels are most sensitive and significant than Serum CRP of prognosis of MPM and determine the achieved benefits from surgery within multimodality therapy. Surgery within multimodality therapy of MPM, increase the survival rate of the MPM pts more than chemo radiotherapy of that pts.

[Ahmad Anwar El Noury, Hany Hasan Mohamed El Sayed, Ahmad Mohamed Mohamed Mostafa, Ahmad Mosaad Zaky. Comparison between circulating biomarkers Serum CRP and Plasma Fibrinogen levels In Malignant Pleural Mesothelioma patients Before and After Surgical and Chemotherapy Modalities. J Am Sci 2019;15(12):46-53]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 5. doi:10.7537/marsjas151219.05.

Keywords: Comparison; circulating; biomarker; Serum; CRP; Plasma; Fibrinogen; Malignant; Pleural; Mesothelioma; patient; Surgical; Chemotherapy; Modality

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Thermodynamics, Mechanism and Rate of Corrosion of Copper in Presence of Phosphoric Acid- N-Propanol Mixtures

Hisham A. Abo-El-Dahaba, b,*, Hussam El Desouky^b

^a Department of Chemistry, Faculty of Science, University of Alexandria, Alexandria, Egypt

^b Department of Chemistry, University College, Umm Al-Qura University, Aljamoum, KSA.

hdahab-41@hotmail.com

Abstract: The corrosion behavior of copper in the presence of phosphoric acid-n-propanol has been studied by using different techniques, including limiting current density measurements and rotating disk electrode method. The influence of organic solvent addition on the rate of corrosion of copper was achieved using the rotating disk electrode technique. Dimensionless correlation between different parameters such as, temperature, speed of rotation of copper disk and viscosity measurements are obtained. The corrosion rate is affected by electrode height, mole fraction of alcohol and phosphoric acid concentration. Physical properties of solution and Thermodynamic parameters are calculated. The data can be correlated by the following equations: Sh = 1.835 (Sc) ^0.33 (Re) ^0.36 for n-propanol A laminar flow mechanism is known from exponent.

[Hisham A. Abo-El-Dahaba, b, Hussam El Desouky. Thermodynamics, Mechanism and Rate of Corrosion of Copper in Presence of Phosphoric Acid- N-Propanol Mixtures. J Am Sci 2019;15(12):54-62]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 6. doi:10.7537/marsjas151219.06.

Keywords: Kinetics, Mechanism, corrosion, Electropolishing, Mass transfer, Limiting current

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Study of Bcl-1 Single Nucleotide Polymorphism of Glucocorticoid Receptor Gene in Patients with Bronchial Asthma Thesis

Mona Fathy Youssef, Eman Saleh El Hadidi, Menat Allah Ali Shaaban, Sara Abdellatif Khamis

Critical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt

E-mail: drsarasnile2008@outlook.com

Abstract: Objective: Fluid infusion, the most critical step in the resuscitation of patients with septic shock, needs preferably continuous invasive hemodynamic monitoring. The study was planned to evaluate the efficacy of ultrasonographically measured inferior vena cava collapsibility index (IVC CI) in comparison to central venous pressure (CVP) in predicting fluid responsiveness in septic shock. Materials and Methods: Thirty-six patients of septic shock requiring ventilatory support (invasive/noninvasive) were included. Patients with congestive heart failure, raised intra-abdominal pressure, and poor echo window were excluded from the study. They were randomly divided into two groups based on mode of fluid resuscitation – Group I (CVP) and Group II (IVC CI). Primary end-points were mean arterial pressure (MAP) of ≥65 mmHg and CVP >12 mmHg or IVC CI <20% in Groups I and II, respectively. Patients were followed till achievement of end-points or maximum of 6 h. Outcome variables (pulse rate, MAP, urine output, pH, base deficit, and ScvO2) were serially measured till the end of the study. Survival at 2 and 4 weeks was used as secondary end-point. Results: Primary end-point was reached in 31 patients (15 in Group I and 16 in Group II). Fluid infusion, by either method, had increased CVP and decreased IVC CI with resultant negative correlation between them (Pearson correlation coefficient –0.626). There was no significant difference in the amount of fluid infused and time to reach end-point in two groups. Comparison in outcome variables at baseline and end-point showed no significant difference including mortality. Conclusion: CVP and IVC CI are negatively correlated with fluid resuscitation, and both methods can be used for resuscitation, with IVC CI being noninferior to CVP.

[Mona Fathy Youssef, Eman Saleh El Hadidi, Menat Allah Ali Shaaban, Sara Abdellatif Khamis. Study of Bcl-1 Single Nucleotide Polymorphism of Glucocorticoid Receptor Gene in Patients with Bronchial Asthma Thesis. J Am Sci 2019;15(12):63-70]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 7. doi:10.7537/marsjas151219.07.

Key Words: Central venous pressure, fluid responsiveness, hypovolemia, septic shock, sonographic inferior vena cava variability.

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Simvastatin Ameliorates the Glucocorticoid-Induced Osteoporosis in Adult Male Albino Rat

Omyma Kamel Docmac, Makram Fahmy Sidhom, Magdy Said Mostafa, Amal Abd El-Khalek Mahdy

Anatomy Department, Faculty of Medicine, Tanta University, Cairo, Egypt

Omymakamel_2007@yahoo.com

Abstract: Background: Many studies have reported an action of statins on bone metabolism. Aim: The present study was performed to evaluate the effects of Simvastatin drug on femoral diaphysis of an adult male albino rat with glucocorticoid- induced osteoporosis (GIO). Material and Methods: Fourty adult male rats were equally divided as follow; group I (Control) received no medication, group II (Simvastatin group) received Simvastatin, group III (GIO group) received methyl prednisolone and group IV (GIO + Simvastatin group) received methyl prednisolone and simvastatin. Specimens of the middle shafts of femurs were processed for light and electron microscopic study. Morphometric study was done. Percentage of Ca content of bone was measured. Serumcalcium (Ca) & phosphorus (P) levels were measured. Statistical analysis for the collected data was performed. Results: In comparison with control group, group III showed indistinct cement lines, many osteocyte lacunae were empty and others contained very small peripheral nuclei. There was statistically highly significant decrease in the percentage of both Ca content and collagen content of bone with a statistically highly significant increase in the number of osteoclasts. Significant improvement was detected with simvastatin administration in group IV when compared with group III as regard all measured data. There were statistically insignificant changes in serum Ca and P levels among all groups. Conclusion: The administration of simvastatin, in concomitant with glucocorticoids, prevented the marked distortion in normal architecture of bone but not completely.

[Omyma Kamel Docmac, Makram Fahmy Sidhom, Magdy Said Mostafa, Amal Abd El-Khalek Mahdy. Simvastatin Ameliorates the Glucocorticoid-Induced Osteoporosis in Adult Male Albino Rat. J Am Sci 2019;15(12):71-81]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 8. doi:10.7537/marsjas151219.08.

Key words: Simvastatin, osteoporosis, methyl prednisolone, femur.

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Protection against lung toxicity induced by Amiodarone in Albino rats by fish oil

Naglaa A. S. Sarg and Kamal M. Kamal

Anatomy & Embryology Department Faculty of Medicine, Benha University, Egypt

naglasarg@hotmail.com

Abstract: Background: Amiodarone (AD) is a strong anti-arrhythmic drug but has adverse reactions on different organs. Fish oil which is rich in Omega-3 polyunsaturated fatty acids (omega-3 PFAs). Aim of the study: to study the toxicity of Amiodaroneon Albinorat lungs and its withdrawal. It also study the possible protective role of fish oil. Materials and Methods: 32 adult male Albino rats were randomly classified into four equal groups. Group I was kept as control group, group II, administered Amiodaronein a daily dose of 30 mg/kg BW; Group III: Received Amiodarone for 6 weeks; stopped for another6 weeks then the rats were sacrificed. Group IV: Given a daily doses of Amiodarone (30 mg/kg BW) with fish oil 150mg/kg BW. Lungs were prepared for histopathological and Immunohistochemical study. Estimation of oxidative markers ((MDA-SOD- GSH) was done. Results: Light microscopical examination of Group II showed distorted pulmonary architecture. Withdrawal of Amiodarone showed very minimal improvement of lung architecture. Group IV showed more or less normal pulmonary architecture with significant decrease of the amount of collagen fibers deposition in comparison to group II. Immunohistochemical results: TGF immuno-expression was positive in group II & III and negative in group IV. Histochemical results showed marked increase in the mean value of MDA level and marked decrease in SOD and GSH levels in Group II and Group III. Protection with fish oil in Group IV reversed this parameter towards the normal values of the control group. Conclusion: Fish oil ameliorates Amiodarone -induced lung toxicity.

[Naglaa A. S. Sarg and Kamal M. Kamal. Protection against lung toxicity induced by Amiodarone in Albino rats by fish oil. J Am Sci 2019;15(12):82-92]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 9. doi:10.7537/marsjas151219.09.

Keywords: Amiodarone-Fish oil-Omega-3-oxidative markers

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Comparative Study between Intra-Operative Ultrasound and Endoscopic Ultrasound for the Diagnosis of Extra Hepatic Cholestasis

Ahmed Shawky Abd-Elaziz Bayoumi¹, Yaser Ahmed Elsayed Amer¹, Mohamed Magdy Ali Esawy², Ahmed Abd-Elsameh Mahmoud³, Mohamed Abdo Mohamed Zaki⁴

¹Professor of General Surgery, Faculty of Medicine, Al-Azhar University, Egypt

² Professor of General Surgery, Theodor Bilhariz Research Institute, Egypt

³ Assistant Professor of Radiology, Theodor Bilhariz Research Institute, Egypt

⁴ M.B.B.Ch, M.SC, Theodor Bilharz Research Institute (TBRI), Egypt

Mohamed.abdo201325@gmail.com

Abstract: Background: There is an immense difference between causes of obstructive jaundice and it is necessary to assess the presence, the type of obstruction pre-operatively as ill-shosen proсedure сan lead to high morbidity and mortality. During biliary surgery, in both lithiasis and tumors, endoscopic ultrasound (EUS) and intraoperative ultrasound (IOUS) were used due to their great advantage. Objectives: The primary objective was to evaluate the impaсt of EUS and IOUS in сhanging the plan of management of obstruсtive jaundiсe; therefore, their impact on the surgical strategy. Patients and Methods: Aprospeсtive cross sectional study whiсh was сonduсted in the department of surgery, Theodor Bilharz Researсh Institute (TBRI) & AL-AZhar University Hospital from 2017 to 2019 сonsisting of 40 patients (15 сalсular сases, 25 malignant сases) with history of obstruсtive ejaundiсe eaсh patient; will undergo preoperative EUS and IOUS then the results of both to be evaluated. Results: Group A preoperative EUS co-ordinanсe with intraoperative diagnosis was (93.3) %, while The IOUS сo-ordinanсe was 100% with 100% Sensitivity and 100% speсifiсity for both. Group B malignant 45 % was the сo-ordinanсe with pre-operative diagnosis. The IOUS сo-ordinanсe with intraoperative diagnosis was 88 %; the P-Value is <0.001. The result is significant at p=≤0.05. Conclusion: In this study, comparative study between EUS and IOUS revealed that, the сorreсt diagnostiс identifiсation, reaсhed by IOUS, has allowed to: seleсt patients with сanсer really reseсtable, deteсt aссurately СBD stones. It consumesless time and performed easily by an adequately trained surgeon.

[Ahmed Shawky Abd-Elaziz Bayoumi, Yaser Ahmed Elsayed Amer, Mohamed Magdy Ali Esawy, Ahmed Abd-Elsameh Mahmoud, Mohamed Abdo Mohamed Zaki. Comparative Study between Intra-Operative Ultrasound and Endoscopic Ultrasound for the Diagnosis of Extra Hepatic Cholestasis. J Am Sci 2019;15(12):93-103]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 10. doi:10.7537/marsjas151219.10.

Keywords: Intra-Operative Ultrasound, Endoscopic Ultrasound, Extra Hepatic Cholestasis.

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Screening Donated Blood for Transfusion-Transmissible Cytomegalovirus Infection Among Libyans

Farag Bleiblo^1,4*, Abdelhakim Eljaki ¹, Khaled Elwaheishi¹, Eman Almismary, Mabroka Aljlale¹, Rabea Alghazal ², and Mohammed Abraheem ³

¹ Department of Microbiology, Faculty of Science, University of Benghazi, Libya

² Immunology & Virology Laboratory, Benghazi Children Hospital, Libya

³ Department of Botany, Faculty of Arts and Science/Alkufra, University of Benghazi, Libya

⁴ Department of Chemistry and Biochemistry and the Biomolecular Sciences Programme, Laurentian University, Sudbury, ON, Canada, P3E 2C6

*fx_bleiblo@laurentian.ca

Abstract: Human cytomegalovirus (HCMV) is a ubiquitous DNA-containing herpesvirus causes severe and fatal diseases in immunocompromised patients and a prevalent cause of virus-associated birth defects. Blood and apheresis donations intended for transfusion to immunosuppressed individuals, neonates and pregnant women should be screened for evidence of CMV infection prior to the release for clinical use. The effective national programmes for quality-assured screening of donated blood have not yet been fully established, hence this study was undertaken to assess whether any blood borne-CMV infections pose a significant threat to the safety of the blood supplies owing to its seroprevalence in the general population. A total of 200 voluntary blood donor subjects admitted to the Blood Bank of Benghazi/Libya were screened for transfusion-transmissible CMV (TT-CMV) using a highly sensitive CMV total IgG and IgM antibody enzyme immunoassay as well as CMV pp65 antigenemia assays. We determined that the overall seropositivity for IgG antibodies (80.50 % ) was higher than that of IgM antibodies (39.00 %), but only 2 (1.00 %) individuals out of these donors were seropositive for the CMV-antigenic protein pp65. The frequency of CMV infection based on gender was incomparable due to the small population number of females. According to age, there was not influence of various age groups on prevalence of anti-CMV IgG antibodies, while a progressive increase in seropositivity of CMV-IgM antibodies with age was detected. The age groups were not significantly associated with CMV prevalence. In contrast, only 2 (1.00 %) patients were shown to be positive for all three performed assays indicating a recurrent infection. Our findings prove a risk of primary transfusion-associated transmission of CMV and may provide a policy guidance on ensuring safe blood supplies accessible to all patients who require transfusion.

[Farag Bleiblo, Abdelhakim Eljaki, Khaled Elwaheishi, Eman Almismary, Mabroka Aljlale, Rabea Alghazal, and Mohammed Abraheem. Screening Donated Blood for Transfusion-Transmissible Cytomegalovirus Infection Among Libyans. J Am Sci 2019;15(12):104-108]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 11. doi:10.7537/marsjas151219.11.

Keywords: CMV, Seroprevalence, Blood Transfusion, TT-CMV, Enzyme Immunoassays

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Regression of Barrett's Esophagus after Nissen fundoplication

Reda Saad; Abd-Allah Hamed; Mohamed Abouzeid and Wadie Boshra

Department of General Sugery, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.

E-mail: abouzeid2000@hotmail.com

Abstract: The frequency of Barrett's esophagus (BE) is elevating, and the treatment is challenging. Antireflux surgery has the prospective to prevent reflux and persuade quiescent mucosa on long term-outcome. This study was conducted on 22 patients having GERD with Barrette's esophagus without dysplasia, who underwent anti-reflux surgery by laparoscope (laparoscopic Nissen fundoplication) at Ain-Shams university hospitals General Surgery Departments (El-DEmerdash and Ain-Shams specialized hospitals) from January 2016 to August 2019, two patients were omitted from the study because they did not adhere to follow up, so the final number was 20 patients, there were 12(60%) males and 8(40%) females with mean age 44 years ( range 28-63 years). Patients were classified according to the level of biopsies into two groups: Group (I) patients with short segment BE, and Group (II) patients with long segment BE. The goal of the work was to assess the impact of Nissen fundoplication on Barrett's esophagus (BE) without dysplasia for patients having long standing Gastro-Esophageal Reflux Disease (GERD) Our results showed that post-operative endoscopy and biopsies in which group I short segment patients showed 70% complete regression, 23% partial regression and 7% with no regression while group II long segment patients showed 28.6% complete regression, 14.3% partial regression and 57.1% with no regression. Conclusion and recommendation: Nissen fundoplication causes regression of Barett’s esophagus with better results in short segment disease than those with long segment disease. For patients having long segment Barrett’s esophagus (LSBE), we advise to destroy this abnormal segment of Barrett’s esophagus using endoscopic mucosal resection (EMR) or endoscopic sub-mucosal resection (ESD) or radiofrequency (RF) to be followed by surgery as these patient may require longer period for their Barrett’s esophagus to regress.

[Reda Saad; Abd-Allah Hamed; Mohamed Abouzeid and Wadie Boshra. Regression of Barrett's Esophagus after Nissen fundoplication. J Am Sci 2019;15(12):109-115]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 12. doi:10.7537/marsjas151219.12.

Keywords: Barrett's esophagus, Nissen fundoplication, regression

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Comparison between the circular and linear stapled technique in Laparoscopic Roux-en-Y gastric bypass.

Mohamed Magdy MD, Waleed Ibrahem MD, Mohamed Aboul Naga MD.

General Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

mmagdy25@hotmail. com .

Abstract: Background: Obesity is considered one of the leading causes of death around the world. Sever obesity is defined as having a body mass index (BMI) of more than 35 kg/m², while the morbid obesity is having a body mass index greater than 40 kg/m² Obesity can be treated using surgical or non-surgical approaches, surgical options are the considered to be the lone option which guarantee satisfactory, long-term weight loss. Roux-en-Y gastric bypass (RYGB) is considered to be one of the commonest techniques of bariatric surgery. Gastrojejunostomy (GJ) can be done using one of three different approaches; hand-sewn, using a circular stapler (CS), or using a linear stapler (LS). Aim of the work: The aim of this study is to compare between the usage of the circular stapler and the linear stapler techniques regarding the outcome of the surgery and the post-operative complications. And being able to reach a conclusion regarding the best technique to be used in the laparoscopic Roux-en-Y gastric bypass bariatric surgeries. Material and methods: This study is a retrospective cohort study, conducted in Ain Shams University Surgery Hospital in Cairo between June 2016 and September 2018. The inclusion criteria for the patients to enter the study was to have a primary laparoscopic Roux-en-Y gastric bypass performed by CS or LS technique, to have a body mass index (BMI) of 40 kg/m2 or more, aged between 25 and 60 years. The exclusion criteria was for the patient to have a history of previous weight loss, previous surgery and a cases with insufficient necessary data. The final sample size was 136 patients, 66 of them underwent LRYGB using linear stapler technique, and the other 70 underwent the circular stapler technique. Results: The total operative time was significantly longer in the linear staple group 149 (99-175) min vs. 85 (65-110) min in the circular stapler group (p < 0.001). The incidence of post-operative hemorrhage was significantly lower in the linear stapler group 2 (1.32%) comparing with 9 (5.94%) in the circular stapler group (p = 0.02). the mean length of the hospital stay time was significantly shorter in the linear stapler group 3(2–6) days comparing with 5 (3–7) days in the circular stapler group (p < 0.001). The LRYGB-LS technique was associated with less post-operative wound infections 1 (0.66%) comparing with 7 (4.62%) in the LRYGB-CS group (p = 0.01). there was no difference between the two groups regarding the readmission ratio (p = 0.59). and there was no significant difference between both groups regarding the incidence of anastomotic leakage, stricture, port side hernias and marginal ulcers. Conclusions: Our results suggest that both circular stapler and linear stapler Laparoscopic Roux-en-Y gastric bypass techniques are considered safe and associated with a low risk to develop any post-operative complications. The incidence of post-operative hemorrhage and infections are slightly higher with the use of circular stapler technique, while the operation time was significantly shorter.

[Mohamed Magdy, Waleed Ibrahem, Mohamed Aboul Naga. Comparison between the circular and linear stapled technique in Laparoscopic Roux-en-Y gastric bypass. J Am Sci 2019;15(12):116-121]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www. jofamericanscience. org. 13. doi:10.7537/marsjas151219.13.

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Keywords: Comparison; circular; linear; stapled technique; Laparoscopic Roux-en-Y gastric bypass

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Effect of Exogenous Stem Cells versus Mobilization of Endogenous Stem Cells on the Nonalcoholic Fatty Liver of Adult Male Albino Rat (Histological and Immunohistochemical Study)

Asmaa Azzam, Emad S. Mishriki, Aml Abo Elala and Fotna Eskander

Department of Anatomy, Faculty of Medicine, Tanta University, Egypt

E-mail addresses: asmaa.azzam@med.tanta.edu.eg

emad.mishriki@med.tanta.edu.eg

Abstract: Introduction: Nonalcoholic fatty liver diseases are currently the most common chronic liver disease. Mesenchymal stem cells have been approved for their hepatoprotective effect and as a substitute for liver transplantation. Stem Enhance (SE) is a hematopoietic stem cell mobilizer which has antioxidant and cholesterol-regulatory effects. Material and methods: Sixty adult male albino rats were used. Ten rats were used for preparation of stem cells. For ten weeks, fifty rats were divided into control and experimental groups. Group-I (Control) was twenty rats divided into two equal subgroups: Ia (negative control) and Ib (SE control). Group-II (Experimental) was thirty rats received high fatty diet (HFD) and after six weeks they subdivided into three equal subgroups: IIa (HFD with no treatment), IIb (SE treated) and IIc (BM-MSCs treated). Body weight, liver enzymes and serum lipids were measured. Liver specimens were stained using different histological and immunohistochemical techniques. Results: Subgroup IIa showed enlarged yellowish liver with disturbed architecture, marked steatosis, inflammatory cells and fibrosis with highly significant increase in the mean level of serum lipids and liver enzymes. Subgroup IIb showed moderate restoration of hepatic architecture with mild distribution of steatosis and fibrosis was decreased. Subgroup IIc revealed restored normal hepatic architecture with mild steatosis and markedly diminished fibrosis. Liver enzymes and serum lipids were decreased in subgroups IIb and IIc at different degrees. Conclusion: It could be concluded that exogenous bone marrow derived stem cell transplantation presents a better therapeutic approach for the nonalcoholic fatty liver diseases as compared to mobilization of endogenous stem cells using Stem Enhance.

[Asmaa Azzam, Emad S. Mishriki, Aml Abo Elala and Fotna Eskander. Effect of Exogenous Stem Cells versus Mobilization of Endogenous Stem Cells on the Nonalcoholic Fatty Liver of Adult Male Albino Rat (Histological and Immunohistochemical Study). J Am Sci 2019;15(12):122-138]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 14. doi:10.7537/marsjas151219.14.

Key words: NAFLD, BM-MSCs, Stem Enhance, exogenous stem cells, endogenous stem cells.

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Effect of Platelet-Rich Plasma on Resorption Rate of Large Volume Autologous Fat Transfer as Evaluated by Computed-Tomography Volumetry

Ahmed A Elhefnawy¹; MSc, Kareem G Al Sharkawy¹; MD, Sameh Elghamry¹; MD. Walid A Mostafa¹; MD, Mohamed A Eltomey²; MD, Elsayed M Mandour¹; MD.

¹Plastic and Reconstructive Surgery Department, Faculty of Medicine, Tanta University, Egypt.

²Diagnostic Radiology Department, Faculty of Medicine, Tanta University, Egypt.

Drahmedashraf10@gmail.com

Abstract: Background and objectives: Although fat grafting is a very common procedure that is being practiced among plastic surgeons, serving diverse purposes ranging from post-traumatic reconstruction to mere aesthetic enhancements of body contour, however the level of evidence beyond such practice is still lacking. Despite clinical optimism associated with autologous fat transfer, uncertainty remains among practitioners regarding the viability of transplanted fat. The optimal technique for harvesting, processing, and grafting continues to be debated. Graft resorption remains highly variable, with 40 to 80 percent graft take reported. The aim of this study is to evaluate the resorption rate of large volume of autologous fat transfer using CT volumetry and the effect of platelet-rich plasma on that rate. Methods: The study is a prospective randomized clinical trial. Patients included in the study were100 patients seeking breast or buttocks augmentation by autologous fat transfer, in all cases the left side was injected with PRP. CT volumetry was done to evaluate fat desorption. Results: we found that the percentage of fat resorption was around (37%). We also found no significant difference in resorption in the PRP injected sides compared to the non-injected side. Conclusion: Resorption rate following large volume fat transfer is around 37% and Platelet rich plasma has no effect on resorption rate. Still, most of patient gave very satisfactory outcome, with no complications which reflect superior result of fat injection as an aesthetic procedure.

[Ahmed A Elhefnawy, Kareem G Al Sharkawy; Sameh Elghamry; Walid A Mostafa, Mohamed A Eltomey; Elsayed M Mandour. Effect of Platelet-Rich Plasma on Resorption Rate of Large Volume Autologous Fat Transferas Evaluated by Computed-Tomography Volumetry. J Am Sci 2019;15(12):139-148]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 15. doi:10.7537/marsjas151219.15.

Key words: Fat grafting, Platelet rich plasma (PRP), Fat resorption, CT volumetry.

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Flexural Strength of two Different Ceramic Materials Bonded to CAD/CAM Titanium (In Vitro Study)

Yousreya Shalaby PhD¹, Dawlat Mostafa PhD^2,3 and Lamiaa Hamdy BDS⁴

^1,4Department of Conservative Dentistry (Fixed Prosthesis), Faculty of Dentistry, Alexandria University, Egypt.

²Department of Dental Biomaterials, Faculty of Dentistry, Alexandria University, Egypt.

³College of Dentistry, The Arab Academy for Science and Technology and Maritime Transport (AASTMT)/El-Alamein, Egypt.

yashalaby@yahoo.com; dwlat.mostafa@yahoo.com; lamiaahamdy1204@gmail.com

Abstract: Introduction: Metal-Ceramic bonding could be considered as a crucial issue for efficacious dental restorations. Zirconia is a promising ceramic alternative to porcelain in modern dentistry. Objectives: The purpose of this study was to investigate the flexural strength of low fusing porcelain and CAD/CAM zirconia materials bonded to CAD/CAM titanium by the effect of sandblasting with 50μm aluminum oxide and application of bonding agent. Materials and Methods: A CAD/CAM machine was used to mill 36 titanium bar specimens of Grade 2 titanium in the dimensions of (25.0 mm × 3.0 mm × 0.5 mm). The specimens were divided into two equal groups (N=18) and sandblasting was performed to one of these groups using 50μm aluminum oxide. Each of these groups (Sandblasted and non-sandblasted) were further sub grouped into two equal groups (N=9) according to veneering material either low-fusing porcelain or CAD/CAM zirconia. A universal testing machine was used to perform the   3-point bending test. The titanium-porcelain and titanium-zirconia interfaces were subjected to stereomicroscopic as well as scanning electron microscopic analysis. The bond failure data (MPa) were analyzed using Student t-test. Results: The debonding test showed that sandblasted subgroups veneered with either low fusing porcelain or zirconia resulted in the strongest titanium-ceramic bond (29.09 ± 2.69 MPa and 32.41 ± 1.29 MPa). Whereas, non- sandblasted subgroups veneered with both low fusing porcelain and zirconia resulted in unsatisfactory bond strength (13.14± 1.93 and 12.27 ± 1.90). The photomicrographs of the titanium surface after debonding demonstrated more residual porcelain retained on the metal surface for sandblasted subgroups. Conclusions: Sandblasting with alumina produced a significant increase in the bond strength between titanium and the veneering material while application of bonding agent alone without sandblasting resulted in insufficient bond strength. Bonding between zirconia and titanium by means of bonding agent in the presence of sandblasting showed significant results comparable to that of low fusing porcelain.

[Yousreya Shalaby, Dawlat Mostafa and Lamiaa Hamdy. Flexural Strength of two Different Ceramic Materials Bonded to Cad/Cam Titanium (an in Vitro Study). J Am Sci 2019;15(12):149-156]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 16. doi:10.7537/marsjas151219.16.

Keywords: Flexural Strength; Different Ceramic Material; Bonded CAD/CAM Titanium

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The Use of Arterial Lactate Level as a predictor of Major Complications after Cardiac Surgery

Prof. Dr. Mohamed Hossam Eldin Hamdy Shokeir, Dr. Sanaa Mohammed Mohammed Elfawal, Mahmoud Ahmed Elsayed Elsheikh

Anesthesiology, Intensive Care and Pain Management Department, Faculty of Medicine, Ain-shams University, Cairo, Egypt

Elshiekh76@gmail.com

Abstract: Coronary artery bypass graft surgery (CABG) remains the most common operation performed by cardiac surgeons today. Improvements in intraoperative technique and perioperative care have led to CABG being offered to a more broad patient profile with less complications and adverse events. Nevertheless, many complications of CABG are reported. Previous studies reported mortality rates after isolated CABG ranging from 2.6% to 12.2%. Determining predictive factors for mortality and morbidity is very important in the management of patients with cardiac surgery. Elevated Lactate levels have been associated with increased morbidity and mortality in a diverse patient population including: trauma, sepsis, multiple organ failure and elderly patients. However, few studies have looked at lactate’s role as an independent predictor of mortality in patients undergoing CABG. Therefore, we conducted the present prospective cohort study to evaluate the role of blood lactate level as a predictor of major complications after cardiac surgery including mortality. The present prospective study was conducted at Ain Shams university hospital and Mahalla Cardiac Center. Seventy adult patients who underwent elective CABG with cardiopulmonary bypass were included. Then, patients were divided into two groups of thirty-five in each. Group (1) with low lactate level (lactic acid blood level<2 mmol/l). Group (2) with high lactate level (lactic acid blood level >2mmol). In the present study, the mean age of the included patients was 58.2 ±6.4years and the majority of patients were males (68.8%). In our cohort, more than 50% of the patients had diabetes or hypertension. The results showed that the rate of in-hospital mortality was 14%; while the rate of morbidity was 34%. The most commonly encountered morbidities in high group were pneumonia (11.4%) and low cardiac output syndrome (LCOS) (8.6%). In the present study, we assessed the associations between blood lactate levels and postoperative mortality. We found that there were significant changes in serum lactate level in studied groups over the first 48 hours of ICU admission (p <0.05). Our analysis indicated that patients with high lactate levels had significantly higher rates of mortality than patients with low lactate levels (p <0.001). On the other hand, our analysis showed that patients with high lactate levels had significantly longer ICU stay than patients with low lactate levels (p =0.019). In contrary, there were no significant differences between both groups in terms of duration of MV (p =0.62) and ward stay (p =0.205).

[Mohamed Hossam Eldin Hamdy Shokeir, Sanaa Mohammed Mohammed Elfawal, Mahmoud Ahmed Elsayed Elsheikh. The Use of Arterial Lactate Level As A predictor Of Major Complications after Cardiac Surgery. J Am Sci 2019;15(12):157-165]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 17. doi:10.7537/marsjas151219.17.

Keywords: Comparative; Evaluation; Surface; Roughness; Novel; Micro-filled; Hybrid; Composite; Conventional; Contemporary; Polishing Systems; Dimensional Profilometry

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Efficacy of Vented Bone Block Fixed with Laser Sintered Implants Restoring Defects In posterior mandibular zone

Mohamed H. ElKenawy¹, Sally S. Abelsameaa², Ziad A. Elmissiry ³

¹Professor of oral and maxillofacial surgery, faculty of dentistry, Mansoura University. Prior president of Mansoura University, Egypt.

²Assistant professor of oral and maxillofacial surgery, faculty of dentistry, Mansoura University, Egypt.

³Teaching assistant oral and maxillofacial surgery, faculty of dentistry, Mansoura University, Egypt.

Abstract: Problem statement: Onlay grafting has been used successfully in the correction of vertically deficient edentulous ridges, although the reported two-stage approach results in considerable resorption of the bone graft before implant insertion. Xenogenic bone grafting overcomes the obstacles of autogenic grafting such as amount needed and the second surgery site and have been manufactured by the tutoplast technology. Direct laser metal sintering technology applied in implant production to improve implant success rate in such difficult bone condition. So, this study was directed to evaluate efficacy of using a vented xenogenic bone block fixed directly with direct laser metal sintering implants in posterior mandible. Patients and Methods: Forteen patients were selected which are free from any systemic disease, aged from 18-50 years old and have a vertical and horizontal bone defect in the posterior mandibular region ranged from 3 to 5 mm 3 dimensionally. All patients within this study received DLMS dental implant installed in the posterior mandibular region as a fixative screws for the xenogenic block graft and were subjected to delayed loading after 6 month. All patients were evaluated clinically at regular time intervals at 6,9 and 12 months postoperatively regarding to implant stability, periodontal probing depth, Modified sulcus bleeding Index (MSBI) and marginal bone loss (MBL). Results: Evaluating this technique in restoring a vertical and horizontal mandibular defect we found that, a statistical significant difference was recorded immediately comparing all the time intervals, at the placement of final crown, 9 and 12 month with (P<0.001) regarding to implant stability. Also, a statistical significant difference was recorded comparing all the time intervals with (P<0.001) except comparing (T2-T3) there was no statistical deference with (P=0.06) regarding the marginal bone loss. Regarding the (MSBI) and the pocket depth a statistical significant differences were recorded between (T1-T2) (T1-T3) with a (P1=0.027 P2=0.002 \ P1=0.001 P2=0.001) respectively and no statistical difference between (T2-T3) with (P3=0.08\ P3=0.09) respectively. Conclusion: We concluded that using the xenogenic bone block fixed with DLMS implants in restoring posterior mandibular vertical and horizontal defects have shown a marked graft resorption and graft dehiscence. On the other hand, the DLMS implants has shown a marked increase in stability over time and fast natural bone formation but failed to ossteointegrate with the xenogenic block when used at the same time as a fixative screws for the block.

[Mohamed H. ElKenawy, Sally S. Abelsameaa, Ziad A. Elmissir. Efficacy of Vented Bone Block Fixed with Laser Sintered Implants Restoring Defects In posterior mandibular zone. J Am Sci 2019;15(12):166-173]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 18. doi:10.7537/marsjas151219.18.

Keywords: Xenogenic bone block, DLMS implants, mandibular defects

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Volumetric Variations of the Human Orbit and Its Relation to the Eye ball and Morphology of Frontal and occipital cerebral Cortex Magnetic Resonance Imaging Study

Sarah Ibrahim^1*, Manal Ibrahim El˗Bermawy¹, Mona Mohammed Zoair¹, Amal Elkattan¹, Mohamed Adel Eltomey²

¹Department of human anatomy and embryology, Faculty of Medicine, Tanta University, Egypt.

²Department of diagnostic radiology, Faculty of Medicine, Tanta University, Egypt.

E mail: sara.ibrahim@med.tanta.edu.eg

Abstract: Background: The orbit of eye is a craniofacial structure that can be exposed to different types of disorders. The measurements of the orbital volume have important for estimating craniofacial asymmetry during clinical examination and for estimation of the sternness of the hurt and prospected complications in planning for surgical operation and in postoperative assessment. Aim of the work: This investigation was designed to identify the volumetric variations of human orbit and evaluate the volumetric relations between the orbit, eyeball and frontal and occipital cortical gray matter by MRI. Subjects and methods: Fifty healthy individuals of both sexes aged from 20 years to 60 years were examined. The participating individuals were selected from MRI scanning unit, Radiology Department, Tanta University Hospital. The volume of orbit, eye ball and their relation to the cortical gray matter volume of frontal and occipital lobes were measured by MRI using the slicer 4.8.1 software and the effect of age, gender and side difference were evaluated. Frontal and occipital gyri volumes were calculated by Free Surfer to understand how the orbit and eyeball varied in correlation with both visual- and frontal cortical gyri which are related indirectly with visual processing. Data were statistically analyzed. Results: There was rightward asymmetry of orbital volume in males and females with significant positive correlation with age and a statistically highly significant difference between males and females. There was rightward asymmetry of eye ball volumes in males. It was found that the volume of eye ball decreased significantly with advanced in ages particularly in males, whereas, a non-significant correlation in females. There was highly significant difference of the total mean values of the right and left eye ball volumes between males and females. Orbital and eye ball volumes were weakly correlated, whereas the orbital and eyeball volumes were also found to be related with frontal lobe gyri than with occipital lobe gyri. Conclusion: It could be concluded that the effect of normal aging, gender and side differences was observed on orbital cavity and eyeball. Also, orbital and eyeball volumes were weakly correlated, and that the structural relationship of frontal lobe was more relevant than the functional relationships between orbit, eyeball and occipital lobe of the visual system.

[Sarah Ibrahim, Manal Ibrahim El˗Bermawy, Mona Mohammed Zoair, Amal Elkattan, Mohamed Adel Eltomey. Volumetric Variations of the Human Orbit and Its Relation to the Eye ball and Morphology of Frontal and occipital cerebral Cortex Magnetic Resonance Imaging Study. J Am Sci 2019;15(12):174-184]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 19. doi:10.7537/marsjas151219.19.

Key words: MRI; orbit; eyeball; frontal lobe; occipital lobe.

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Manifestations, Early Detection and Management of Rhabdomyolysis in Critically Ill Patients in ICU

Prof. Dr. Mohamed Hossam Shokeir, Dr. Ashraf Nabil Saleh, Khaled Mostafa Mohamed Al-Gendy

Anesthesia and Intensive Care Depaerment, Faculty of Medicine Ain - Shams University, CAuro, Egypt

khaledalgendy81@gmail.com

Abstract: Rhabdomyolysis is the rapid breakdown of striated muscles caused by wide variety of conditions including trauma, drugs, viruses, metabolic disorders; Rhabdomyolysis is a potential fatal condition with mortality of approximately 8%. In the ICU setting, the most common causes of rhabdomyolysis are muscular trauma and vascular obstruction. Rhabdomyolysis occurs in up to 85% of patients with traumatic injuries. Alcohol has been implicated in the development of rhabdomyolysis in up to 20% of cases. Patients with severe injuries that develop rhabdomyolysis induced renal failure have a mortality of approximately 20% but are higher if multiple organ dysfunction is present. Causes of rhabdomyolysis are divided into hereditary and acquired ones. The hereditary causes are mainly related to a lack or insufficiency of enzymes that participate in the catabolism of different energy macromolecules, the acquired causes are classified as traumatic and non-traumatic. The traumatic ones, such as crush syndrome, accidents, natural disasters, or intense exercise, cause direct muscle injury and rupture of the sarcolemma. The non-traumatic causes are the most common ones during peacetime and include alcohol abuse, medicines e.g., statins. The classic triad of symptoms of rhabdomyolysis includes muscle pain, weakness and dark urine. Diagnosis of rhabdomyolysis is based on elevated serum creatine kinase (CK) levels more than 1000u/L. Mild rhabdomyolysis can be treated by drinking lots of fluids. Severe cases require hospitalization and aggressive treatment with intravenous fluids to dilute the proteins to minimize their damage to the kidney and monitor the heart for dangerous rhythm changes from the surge of electrolytes. In severe cases, the kidneys may fail and immediate dialysis is needed to mechanically remove proteins and electrolytes from the blood. The complications of rhabdomyolysis include: hypovolemia, compartment syndrome, arrhythmia, disseminated intravascular coagulation, hepatic dysfunction and acute renal failure. Acute kidney injury associated with myoglobinuria is the most serious compilation of both traumatic and non-traumatic rhabdomyolysis, and it may be life-threatening. The reported incidence ranges from 13% to approximately 50%.

[Mohamed Hossam Shokeir, Ashraf Nabil Saleh, Khaled Mostafa Mohamed Al-Gendy. Manifestations, Early Detection and Management of Rhabdomyolysis in Critically Ill Patients in ICU. J Am Sci 2019;15(12):185-199]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 20. doi:10.7537/marsjas151219.20.

Keywords: Manifestation; Detection; Management; Rhabdomyolysis; Critically; Patient

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Assessment of Expression of Phosphorylated CXCR4 in AML Blast cells and Its Relation to the Disease Prognosis

Manal A. Eid¹, Basma M. Elgamal¹, Mohamed Attia², Mennatallah Hamdy¹

¹ Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta Egypt

²Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt

Abstract: Background: The G protein-coupled receptor CXCR4 is activated by CXCL12 (stromal cell-derived factor 1) and is involved in the control of migration and homing of cells notably for engraftment of normal and neoplastic hematopoietic cells (including AML) in the bone marrow (BM) including AML. CXCR4 phosphorylation has been shown to affect its internalization. CXCR4 endocytosis has been reported to modify its signaling and other downstream signaling pathways including ERK cascade activation. The aim: evaluating (immunhistochemically) the CXCR4 (phosphorylated and unphosphorylated) expression in bone marrow biopsy blast cells and the correlation of these markers with AML prognosis. Patients & methods: The study was performed on 20 adult patients with newly diagnosed AML, their age ranged from 20 to 64 years. All patients were subjected to the following: detailed history, clinical examination, routine investigations for AML diagnosis and immunohistochemistry of bone marrow biopsy samples to detect CXCR4 and phosphorylated CXCR4-S339 expression. Result: By analysis of survival and using kaplanmeier survival analysis, it has been found that expression of ph-CXCR4 is more significant than CXCR4 expression. Ph-CXCR4 correlated well with survival data (OS & DFS) unlike CXCR4 which did not play a significant role. Conclusion: Homing of these blasts actively dividing to the bone marrow niche is suggested to be regulated by G protein-coupled receptor CXCR4specifically its active phosphorylated form, which has been proved to be associated with bad prognosis of AML.

[Manal A. Eid, Basma M. Elgamal, Mohamed Attia, Mennatallah Hamdy. Assessment of Expression of Phosphorylated CXCR4 in AML Blast cells and Its Relation to the Disease Prognosis. J Am Sci 2019;15(12):200-207]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience.org. 21. doi:10.7537/marsjas151219.21.

Keywords: Assessment; Expression; Phosphorylated; CXCR4; AML; Blast cell; Relation; Disease; Prognosis

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